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

Abstract

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Metastatic uveal melanoma: The final frontier

“…Gender is not statistically associated with OS in 8 of 11 prognostic analyses of 24-224 patients (Eskelin et al, 2003;Gragoudas et al, 1991;Kodjikian et al, 2005b;Mariani et al, 2019;Nicholas et al, 2018;Rantala et al, 2021aRantala et al, , 2021bXu et al, 2019) (Table 4A). However, all these analyses consistently return a hazard ratio (HR) > 1.0 (Fig.…”

“…Early diagnosis of metastases is considered necessary to maximize the number of patients who may benefit from active treatment, especially from surgery and other liver-directed treatments (Francis et al, 2013;Gomez et al, 2014;Mariani et al, 2009Mariani et al, , 2016Rantala et al, 2019Rantala et al, , 2021bRivoire et al, 2005;Tulokas et al, 2018;Xu et al, 2019). In practice, when an early diagnosis was attempted in high-risk patients with 6-monthly MRI-based surveillance, 25% were eligible for hepatic resection and 8% eventually received a microscopically complete (R0) resection (Piperno-Neumann et al, 2015).…”

“…Currently, each referral center has its preferred imaging modality and frequency of surveillance. The frequency varies by center depending on availability and experience with specific treatments for metastases, especially liver surgery, and by patient, depending on their perceived individual risk for dissemination, informed by tumor stage, histology, and genetic characteristics of the primary tumor (Choudhary et al, 2016;Davanzo et al, 2019;Diener-West et al, 2004;Eskelin et al, 1999;Gomez et al, 2014;Piperno-Neumann et al, 2015;Rantala et al, 2021aRantala et al, , 2021b.…”

“…In Europe, upper abdominal US is widely used for initial screening and surveillance which generally continues for 10-15 years, and CT and MRI are scheduled if a suspicious new lesion is detected (Eskelin and Kivelä, 2002;Eskelin et al, 1999;Gombos et al, 2004;Rantala et al, 2020bRantala et al, , 2021aRantala et al, , 2021bRivoire et al, 2005;Servois et al, 2010). Scottish consensus-based guidelines even propose that patients judged to be at high-risk of developing metastases should have life-long 6-monthly surveillance (Chadha et al, 2019).…”

Patients presenting with stage IV uveal melanoma: Lessons learned

“…[ 8 9 ] Though in the absence of staging the evidence remains weak, patients stage IV UM who have received chemoimmunotherapy, selective internal radiation therapy, or surgical resection have survived longer. [ 8 10 ]…”