Liver Function Testing Is Not Helpful for Early Diagnosis of Metastatic Uveal Melanoma

Mouriaux, Frédéric; Diorio, Caroline; Bergeron, Dan; Berchi, Célia; Rousseau, A.

doi:10.1016/j.ophtha.2012.01.045

Cited by 23 publications

(14 citation statements)

References 25 publications

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“…Notably, the authors showed that the association of LFTs with abdominal ultrasonography (USG) every 6 months would identify over 95% of asymptomatic patients [317]. However, a more recent study showed that the sensitivity and metastasis prediction value of LFTs is very poor, although normal LFTs have a negative predictive value of 90% and identify patients with low chance of having metastases [318]. Also, a retrospective study on a cohort of 263 UM patients showed that only 13% of patients with USG-detectable metastasis had simultaneous abnormal LFTs [319].…”

Section: Biomarkersmentioning

confidence: 99%

The biology of uveal melanoma

Amaro

Gangemi

Piaggio

et al. 2017

Cancer Metastasis Rev

186

193

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Uveal melanoma (UM), a rare cancer of the eye, is distinct from cutaneous melanoma by its etiology, the mutation frequency and profile, and its clinical behavior including resistance to targeted therapy and immune checkpoint blockers. Primary disease is efficiently controlled by surgery or radiation therapy, but about half of UMs develop distant metastasis mostly to the liver. Survival of patients with metastasis is below 1 year and has not improved in decades. Recent years have brought a deep understanding of UM biology characterized by initiating mutations in the G proteins GNAQ and GNA11. Cytogenetic alterations, in particular monosomy of chromosome 3 and amplification of the long arm of chromosome 8, and mutation of the BRCA1-associated protein 1, BAP1, a tumor suppressor gene, or the splicing factor SF3B1 determine UM metastasis. Cytogenetic and molecular profiling allow for a very precise prognostication that is still not matched by efficacious adjuvant therapies. G protein signaling has been shown to activate the YAP/TAZ pathway independent of HIPPO, and conventional signaling via the mitogen-activated kinase pathway probably also contributes to UM development and progression. Several lines of evidence indicate that inflammation and macrophages play a pro-tumor role in UM and in its hepatic metastases. UM cells benefit from the immune privilege in the eye and may adopt several mechanisms involved in this privilege for tumor escape that act even after leaving the niche. Here, we review the current knowledge of the biology of UM and discuss recent approaches to UM treatment.

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Section: Biomarkersmentioning

confidence: 99%

The biology of uveal melanoma

Amaro

Gangemi

Piaggio

et al. 2017

Cancer Metastasis Rev

186

193

View full text Add to dashboard Cite

show abstract

“…Even though liver function tests have been proven irrelevant in the diagnosis of hepatic metastases from uveal melanoma [31], wide variation exists concerning the choice of the imaging examination and the frequency of the surveillance [32]. …”

Section: Methodsmentioning

confidence: 99%

Liver Imaging Techniques: Recognition of Uveal Melanoma Metastases

et al. 2018

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Background: The liver is the most common site for metastases of several primary malignancies including uveal melanoma. Methods: Review of imaging characteristics of incidental common benign liver lesions including hepatic cyst, hemangioma, focal nodular hyperplasia, and hepatic adenoma and contrasting them with uveal melanoma metastases. Results: Benign hepatic lesions may be cystic or, if solid, relatively stable in size over time. For hepatic lesions larger than 10 mm in size, characteristic imaging features typically allow for confident diagnosis. When lesions are small (less than 10 mm), definitive characterization can be difficult. Moreover, lesions smaller than 10 mm can be difficult to biopsy under ultrasound or computed tomography (CT) guidance, and short-term follow-up will often be useful to assess for stability or progression. Overall, magnetic resonance imaging is more specific than CT scan and at least as sensitive as CT for detecting uveal melanoma liver metastases. Conclusions: New multiple enhancing solid liver lesions should raise suspicion of uveal melanoma liver metastases. Discussion of challenging cases with the radiologist may be beneficial, as pertinent information such as size, location, and molecular prognostication status of the primary tumor can guide radiological interpretation of hepatic lesions.

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“…However, LFTs are limited by low sensitivity and a poor positive predictive value (PPV). 10 Elevations in LFTs are not specifıc to uveal melanoma but may be the result of inflammation, infection, other malignancies, or liver disease including alcohol and drugs. Groups have disagreed about the most sensitive component of the LFT panel, with some supporting lactate dehydrogenase and others favoring gamma-glutamyl transpeptidase and alkaline phosphatase.…”

Section: Serum Markers Liver Function Testsmentioning

confidence: 99%

“…2 A group from Canada agreed with the ineffectiveness of LFTs as a surveillance method, but it also highlighted a potential benefıt of its high negative predictive value. 10 By that group's calculation, it is important for patients to know "that they have a 97.5% chance or more of having no metastasis in the case of normal LFT results." 10 Of note, it has been suggested that LFTs in combination with other tests may be of value.…”

Section: Serum Markers Liver Function Testsmentioning

confidence: 99%

Surveillance Options for Patients with Uveal Melanoma Following Definitive Management

Francis¹,

Patel²,

Gombos³

2013

American Society of Clinical Oncology Educational Book

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Even though less than 1% of uveal melanoma patients are found to have radiographic or clinical evidence of distant disease at the time of treatment for their intraocular disease, they carry a lifetime risk of disease recurrence, with approximately 50% of patients ultimately developing fatal metastases. Despite this significant risk, there is no consensus within the ophthalmologic or oncologic community regarding the role of surveillance for detection of metastatic disease in these patients. The lack of consensus is due to the notable absence of clear data regarding the best radiologic or serum surveillance modalities, the optimal frequency of testing, or the ideal length of follow-up. Given the ability to assess prognosis by cytogenetics, gene expression profiling, or other methods, questions remain about whether surveillance strategies should be tailored by level of risk. Importantly, no survival benefit from the early detection of asymptomatic disease in uveal melanoma has been documented, resulting in controversy over the value of routine surveillance and advocacy from some clinicians to forego surveillance altogether. However, there are several factors supporting surveillance: the patient's enhanced emotional well-being, the potential to identify oligometastatic disease amenable to surgery or other local therapies, decreased morbidity/complications from advanced disease, and identification of patients eligible for clinical trials that assess novel therapies for advanced uveal melanoma. The selection of surveillance modality used varies according to local expertise and resources and may include serum markers (liver function tests and others) and/or imaging (chest x-ray, abdominal ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging).

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Liver Function Testing Is Not Helpful for Early Diagnosis of Metastatic Uveal Melanoma

Cited by 23 publications

References 25 publications

The biology of uveal melanoma

The biology of uveal melanoma

Liver Imaging Techniques: Recognition of Uveal Melanoma Metastases

Surveillance Options for Patients with Uveal Melanoma Following Definitive Management

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