PROGNOSTIC VALUE OF MORPHOMETRIC FEATURES AND THE CALLENDER CLASSIFICATION IN UVEAL MELANOMAS

Purpose: Cytomorphometric analysis of uveal melanoma has focused on nu cleolar characteristics, although nuclear measurements are easier and more reproducible. In this study, we examine a restricted set of nucle ar and nucleolar cytomorphometric variables in the search for the most quantifiable and reproducible prognostic parameter among these and di scover a means of assessing the malignancy of tumors within the differ ent Callender subgroups. Methods: Uveal melanomas from 94 patients wit h a minimum follow-up of 5 years underwent nuclear and nucleolar morph ometric analysis using a digitized interactive video overlay system. S tatistical analysis included univariate and multivariate survival anal ysis on morphometric variables and classic prognostic parameters (such as Callender cell type, size, etc.). Results: Univariate analysis of cytomorphometric parameters showed the standard deviation of nuclear a rea (NASD) to be the most significant variable (P < 0.0001; Mantel-Cox , 15.2). This was followed by the difference between nuclear and nucle olar areas (P < 0.002; Mantel-Cox, 9.5), the standard deviation of nuc leolar area (SDNA) (P < 0.01; Mantel-Cox, 6.4), and the standard devia tion of the shortest nuclear axis (P < 0.02; Mantel-Cox, 6.4). There w as a trend for significance with the mean of the ten largest nucleoli (P < 0.07). Multivariate analysis of clinical and cytomorphometric var iables showed improvement of prognostic prediction with a combination of ?he NASD, largest tumor dimension, and glaucoma (P < 0.0001; Mantel -Cox, 26.3). Callender cell type was strongly correlated with the NASD (P < 0.0002), the mean axis ratio of ?he nuclear area (P < 0.0007), a nd the mean of ?he ten largest nucleoli (P < 0.0007). Conclusion: Cyto morphometric analysis of uveal melanoma should include nuclear area an d may identify tumors of differing malignancy within the same Callende r class.