Prognostic Factors and Decision Tree for Long-Term Survival in Metastatic Uveal Melanoma

Abstract

PurposeThe purpose of this study was to demonstrate the existence of a bimodal survival pattern in metastatic uveal melanoma. Secondary aims were to identify the characteristics and prognostic factors associated with long-term survival and to develop a clinical decision tree.Materials and MethodsThe medical records of 99 metastatic uveal melanoma patients were retrospectively reviewed. Patients were classified as either short (≤ 12 months) or long-term survivors (> 12 months) based on a graphical interpretation of the survival curve after diagnosis of the first metastatic lesion. Ophthalmic and oncological characteristicswere assessed in both groups.ResultsOf the 99 patients, 62 (62.6%) were classified as short-term survivors, and 37 (37.4%) as long-term survivors. The multivariate analysis identified the following predictors of long-term survival: age ≤ 65 years (p=0.012) and unaltered serum lactate dehydrogenase levels (p=0.018); additionally, the size (smaller vs. larger) of the largest liver metastasis showed a trend towards significance (p=0.063). Based on the variables significantly associated with long-term survival, we developed a decision tree to facilitate clinical decision-making.ConclusionThe findings of this study demonstrate the existence of a bimodal survival pattern in patients with metastatic uveal melanoma. The presence of certain clinical characteristics at diagnosis of distant disease is associated with long-term survival. A decision tree was developed to facilitate clinical decision-making and to counsel patients about the expected course of disease.

Impact of staging on survival outcomes: a nationwide real-world cohort study of metastatic uveal melanoma

“…Although LDH was available only for a subpopulation of patients, our data support that working formulation staging might benefit from additionally considering LDH. We confirmed that DMFI >3.5 years, another proposed independent predictor of OS [ 32 , 34 , 38 ], was associated with longer OS on univariable level; however, it did not improve working formulation staging.…”

“…No consistent source of bias over all stages was detected in these components, however. LDH has previously been proposed to be an independent prognostic factor in patients with metastatic uveal melanoma [ 32 , 34 , 38 ]. Although LDH was available only for a subpopulation of patients, our data support that working formulation staging might benefit from additionally considering LDH.…”

Development of a Prognostic Nomogram for Liver Metastasis of Uveal Melanoma Patients Selected by Liver MRI

“…LDH levels and tumor burden are well-established prognostic markers in different types of cancer (lymphoma, cutaneous melanoma), although the interdependence of these two parameters is currently still being discussed [33]. In UM, only two studies to date have shown that the level of LDH and the volume of liver metastases appear as independent prognostic variables [19,30]. Interestingly, another recent publication, studying the survival of patients with metastatic cutaneous melanoma treated with Pembrolizumab, shows that the tumor size of metastases remains an independent prognostic factor in multivariate analysis among other variables including the LDH level [34].…”

“…The main independent prognostic factors common to these different studies include clinical and biological factors, as well as the evaluation of liver tumor burden determined by different imaging methods. In three more recent retrospective studies [19,29,30], the previously described prognostic factors appear as the main factors determining patient survival: age, performance status, delay in metastasis (DFI), LDH level [19,30] or alkaline phosphatases [29], and the extent of hepatic invasion assessed on imaging. Hepatic invasion can be assessed either by measuring the largest diameter of the largest metastasis [29,30] or by measuring the percentage of liver invasion [19].…”

ALKBH5-mediated m6A demethylation of FOXM1 mRNA promotes progression of uveal melanoma

“…The most common sites of UM metastasis are the liver (60.5%), lungs (24.4%), skin/soft tissue (10.9%), and bone (8.4%) [ 4 ]. Unfortunately, the 1-year survival rate of UM patients with metastases is only 15% [ 5 ]. Therefore, there is a pressing need to find useful prognostic biomarkers and therapeutic targets for this disease.…”