Clinical prognostic factors in patients with posterior uveal malignant melanoma

Abstract

The authors evaluated the prognostic value of clinically assessed variables for predicting length of survival until death from metastatic disease in 237 patient with a primary choroidal or ciliary body melanoma. Using multivariate Cox proportional hazards modeling, the authors identified the largest linear basal tumor diameter (mm), estimated by indirect ophthalmoscopy and fundus drawing, the location of the anterior margin of the tumor relative to the ocular equator and ora serrata, and the age of the patient at the time of treatment as the best combination of the clinically assessed variables for predicting survival. For each patient in this group, the authors computed a prognostic index based on the best multivariate Cox model. They showed that patients with low, intermediate, and high values of prognostic index had low, intermediate, and high melanoma-related mortality rates, respectively, during the first 5 to 8 posttreatment years. These results suggest that: (1) clinically assessed variables evaluated according to a standardized protocol are useful for predicting the survival of treated patients with posterior uveal melanoma and (2) ophthalmologists who assess potential clinical prognostic variables consistently may identify subgroups of patients with comparable mortality risk on the basis of noninvasive testing.

A multimodal approach to eye melanoma: patterns of care and related complications

“…Generally, it is caused by an accumulation of multiple genetic lesions and is fatal in a relevant fraction of cases, even if a successful local control is achieved [1,2]. Several clinical, pathological and cytogenetic features seem to have prognostic value for metastatic disease, such as older patient age, larger tumor size, anterior tumor location, epithelioid histotype and aneuploidy 3 [3][4][5][6][7]. A few recurring chromosomal alterations are associated with the increased risk of metastasis and in particular loss of chromosome 3 and gain of 6p and 8q, but no specific individual genes responsible for carcinogenesis have been clearly demonstrated in these loci [8,9].…”

Gene Expression Profiling in Uveal Melanoma Reveals Two Molecular Classes and Predicts Metastatic Death

“…We next analyzed the tumor classes for correlation with clinical and pathological features (Supplemental File 3). The only feature to demonstrate an association with tumor class was advanced patient age, a known risk factor for metastasis (15). Mean age was 56 years in class 1 and 73 years in class 2 (P ϭ 0.008).…”

Pyrophosphorolysis-Activated Polymerization Detects Circulating Tumor DNA in Metastatic Uveal Melanoma

“…Despite improvement of diagnosis and treatment of the primary tumor, there is no effective treatment of metastatic disease, and approximately half of patients will die within 1 year or less following metastases detection (2). Several parameters are associated with metastasis and poor survival, including (i) clinical factors such as age, tumor diameter and thickness, extraocular extension, (ii) monosomy 3, and (iii) gene expression profiling after enucleation or fine needle aspiration biopsies of the primary tumor (3)(4)(5)(6). An issue in high-risk patients is to detect relapse at the earliest stage after primary tumor treatment.…”