Optimising prediction of early metastasis-free survival in uveal melanoma using a four-category model incorporating gene expression profile and tumour size

Roelofs, Kelsey A.; Grewal, Parampal S.; Lapere, Steven; Larocque, Matthew; Murtha, Albert; Weis, Ezekiel

doi:10.1136/bjophthalmol-2020-317714

Cited by 6 publications

(6 citation statements)

References 36 publications

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“…Moreover, to smooth our analysis of anatomic location, it was necessary to collapse tumors with overlapping anatomic sites as follows: ciliochoroidal tumors were classified as choroidal, and iridociliochoroidal tumors were classified as the ciliary body. Despite these limitations, our study demonstrated the impact of size parameters such as AJCC stage and tumor size for improving metastatic risk assessment of Class 1A tumors in UM, which is line with previous findings that tumor size plays a role in the prognostication of low-risk UM [12,24].…”

Section: Discussionsupporting

confidence: 90%

Metastatic Risk Factors Associated with Class 1A Uveal Melanoma Patients

Ballhausen

Urias

Gruschkus

et al. 2021

Cancers

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In uveal melanoma (UM), gene expression profiling (GEP) is commonly used to classify metastatic risk into three groups (Class 1A, 1B, and 2). Class 1A patients have a lower metastatic risk of 2% at 5 years compared to other groups. We aimed to describe clinical features associated with the development of metastasis in this low-risk group. This single-center IRB-approved retrospective case series review included all UM patients between February 2006 and March 2019 with an archived or fresh specimen classified as Class 1A. Cox regression and receiver operating characteristics analyses were used to identify factors associated with metastasis development and OS. Among 73 UM patients with Class 1A, the 5-year cumulative incidence of local recurrence and distant metastasis was 4.2% and 17.0%, respectively. Stage III disease (HR 20.7; 95% confidence interval (95% CI) 1.4–300.6; p = 0.0264) was found to be independently associated with metastatic recurrence, while primary therapy was associated with OS (enucleation vs. brachytherapy, HR 13.5; 95% CI 1.3–147.6; p = 0.0348). Combined clinical decision-making utilizing factors such as GEP class, American Joint Committee on Cancer (AJCC) stage, and COMS size could have a significant clinical impact by improving risk stratification and adapting follow-up intervals in UM Class 1A patients.

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Section: Discussionsupporting

confidence: 90%

Metastatic Risk Factors Associated with Class 1A Uveal Melanoma Patients

Ballhausen

Urias

Gruschkus

et al. 2021

Cancers

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“…It has also been shown that the largest basal diameter (LBD) of the tumor adds prognostic value when added to the GEP [10, 11]. Recently, Roelofs et al [12] compared prognostic models combining GEP with various variables including LBD and AJCC classification and showed that a combination of GEP and the LBD was a simple method to include both molecular and clinical prognostic data. In clinical practice at our institutions, AJCC staging and GEP classification are discussed with all patients at the point of care.…”

Section: Introductionmentioning

confidence: 99%

Improved Prognostic Precision in Uveal Melanoma through a Combined Score of Clinical Stage and Molecular Prognostication

2021

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Introduction: Prognosis of uveal melanoma (UM) is assessed using clinical staging or molecular testing. Two modalities often used for prognostication are the American Joint Committee on Cancer (AJCC) staging and a tumor gene expression profile (GEP), the outcomes of which are often discordant. This paper discusses a Total Risk Score created to combine the discordant information from both sources. Methods: A retrospective case series was conducted of all patients presenting with UM over six years to two referral centers. Each tumor was classified using the AJCC and the GEP. A Total Risk Score was calculated for each patient using results from both AJCC and GEP. Kaplan-Meier analysis of metastasis free-survival was used to compare groups. Results: A total of 294 patients were included in the study. Kaplan-Meier estimates showed significant curve separation between individual AJCC and GEP risk groups. The combined Total Risk Score provided an accurate estimate of prognosis that incorporated results from both AJCC and GEP. Conclusions: Clinical staging and molecular prognostication of UM can be discordant. There is important information provided by each system that is not provided by the other. The Total Risk Score provides a simple method to combine information from both the AJCC stage and the GEP class in order to provide patients and care teams with a more complete understanding of metastatic risk.

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“…Even after controlling for gene expression profiling (GEP), tumour size has been found to be an independent predictor of metastasis at 5 years [61,62]. While brachytherapy is recommended for medium-sized melanocytic choroid tumours, patients who cannot attend follow-up visits may choose enucleation.…”

Section: Qualifying Statementsmentioning

confidence: 99%

Management of Uveal Melanoma: Updated Cancer Care Alberta Clinical Practice Guideline

Weis,

Surgeoner,

Salopek

et al. 2023

Current Oncology

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Objective: The purpose of this guideline update is to reassess and update recommendations in the prior guideline from 2016 on the appropriate management of patients with uveal melanoma. Methods: In 2021, a multidisciplinary working group from the Provincial Cutaneous Tumour Team, Cancer Care Alberta, Alberta Health Services was convened to update the guideline. A comprehensive review of new research evidence in PubMed as well as new clinical practice guidelines from prominent oncology groups informed the update. An enhancement in methodology included adding levels of evidence and strength of recommendations. The updated guideline was circulated to all members of the Provincial Cutaneous Tumour Team for review and endorsement. Results: New and modified recommendations address provider training requirements, diagnostic imaging for the detection of metastases, neo-adjuvant pre-enucleation radiotherapy, intravitreal anti-vascular endothelial growth factor agents for radiation retinopathy, genetic prognostic testing, surveillance following definitive local therapy, and systemic therapy for patients with metastatic uveal melanoma. Discussion: The recommendations represent evidence-based standards of care agreed to by a large multidisciplinary group of healthcare professionals.

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Optimising prediction of early metastasis-free survival in uveal melanoma using a four-category model incorporating gene expression profile and tumour size

Cited by 6 publications

References 36 publications

Metastatic Risk Factors Associated with Class 1A Uveal Melanoma Patients

Metastatic Risk Factors Associated with Class 1A Uveal Melanoma Patients

Improved Prognostic Precision in Uveal Melanoma through a Combined Score of Clinical Stage and Molecular Prognostication

Management of Uveal Melanoma: Updated Cancer Care Alberta Clinical Practice Guideline

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