Journal of Shanghai Jiao Tong University (Medical Science) ›› 2022, Vol. 42 ›› Issue (5): 617-623.doi: 10.3969/j.issn.1674-8115.2022.05.009

• Clinical research • Previous Articles     Next Articles

Relationship between histopathological features, Ki-67 expression and prognosis of conjunctival melanoma

ZHU Tianyu1,2(), ZONG Chunyan1,2, XU Shiqiong1,2, GE Shengfang1,2, FAN Xianqun1,2, JIA Renbing1,2()   

  1. 1.Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    2.Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
  • Received:2022-03-19 Accepted:2022-05-25 Online:2022-05-28 Published:2022-05-28
  • Contact: JIA Renbing;
  • Supported by:
    The Science and Technology Commission of Shanghai(20DZ2270800);National Facility for Translational Medicine (Shanghai)(TMSZ-2020-206)

Abstract: Objective

·To investigate the relationship between histopathological features, Ki-67 expression and prognosis of conjunctival melanoma (CoM).


·Thirty-six patients with histopathologically confirmed CoM admitted to the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine between August 2008 and September 2020 were selected, and their clinical characteristics and histopathological features data were collected to analyze their clinicopathological characteristics, Ki-67 expression and prognostic relationships.


·Thirty-six patients with CoM were included in this study, including 26 males and 10 females, with a mean age of 57.81 (31?82) years. The site of onset was located in the lacrimal caruncle in 11 cases (30.6%), the fornix in 8 cases (22.2%), and the palpebral conjunctiva in 15 cases (41.7%). One patient (2.8%) had T1 stage disease, 12 (33.3%) had T2 stage disease, and 23 (63.9%) had T3 stage according to the American Joint Committee on Cancer (AJCC) 8th edition staging system. During the follow-up period, local recurrence was observed in 16 patients (44.4%), distant metastases in 17 patients (47.2%) and 16 patients (44.4%) died of disease. The Breslow thickness of CoM tumors was 4.05 (0.2?15.9) mm, with 18 cases (50.0%) >4 mm. Ulceration and regression were observed in 13 cases (36.1%) and 7 cases (19.4%), respectively. Tumor-infiltrated lymphocytes (TILs) were rated as “brisk” in 4 patients (11.1%) and “nonbrisk” in 26 patients (72.2%). Three patients (8.3%) had perineural invasion and 8 patients (22.2%) had vascular invasion. Thirty-five cases (97.2%) were in the vertical growth phase, and microscopic satellitosis was observed in only one case (2.8%). Regarding the histological type, 18 cases (50.0%) were superficial spreading, 12 (33.3%) were nodular, 4 (11.1%) were lentiginous, and 2 were unknown. Ki-67 index>20% was observed in 14 patients (38.9%). Breslow thickness >4 mm indicated high risk of local recurrence (P=0.049) and disease-related death of CoM (P=0.049). Histological ulceration and regression were risk factors for local recurrence (P=0.030) and distant metastasis (P=0.046), respectively. In addition, Ki-67 index was related with local recurrence (P=0.016). Spearman correlation analysis showed that Ki-67 index was positively correlated with local recurrence (P=0.433). CoM patients with a Ki-67 index higher than 20% had a higher risk of local recurrence [hazard ratio (HR) 3.61, 95% confidence interval (CI) 1.26?10.28, Log-rank P=0.011].


·Histopathological features and Ki-67 expression of CoM can be used to predict patient prognosis and help guide clinical treatment.

Key words: conjunctival neoplasms, melanoma, clinicopathology, Ki-67, recurrence, prognosis

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