Cancer Res Treat.  2018 Oct;50(4):1238-1251. 10.4143/crt.2017.534.

Prognoses and Clinical Outcomes of Primary and Recurrent Uveal Melanoma

• Kim JH
• Shin SJ
• Heo SJ
• Choe EA
• Kim CG
• Jung M
• Keum KC
• Yoon JS
• Lee SC
• Shin SJ

• KMID: 2424796
• DOI: http://doi.org/10.4143/crt.2017.534

Abstract

PURPOSE
Uveal melanoma has a very poor prognosis despite successful local primary tumor treatment. In this study, we investigated prognostic factors that more accurately reflected the likelihood of recurrence and survival and delineated a prognostic model that could effectively identify different risk groups based on initial clinical parameters.
MATERIALS AND METHODS
Prognostic factors associated with distant recurrence, recurrence-free survival (RFS), progression-free survival, and overall survival from distant recurrence to death (OS2) were analyzed in 226 patients with stage I-III uveal melanoma who underwent primary local therapy.
RESULTS
Forty-nine patients (21.7%) had distant recurrences, which occurred most frequently in the liver (87.7%). In a multivariate analysis, local radiotherapy improved RFS among patients with multiple recurrence risk factors relative to excision (not reached vs. 19.0 months, p=0.004). Patients with BRCA1-associated protein-1 (BAP1)-negative primary tumors showed a longer RFS duration after primary treatments, while those with BAP1-negative metastatic tissues had a shorter OS2 compared to those with BAP1-positive tumors, both not statistically insignificance (RFS: not reached vs. 82.0 months, p=0.258; OS2: 15.7 vs. 24.4 months, p=0.216). Male sex (hazard ratio [HR], 3.79; p=0.012), a short RFS (HR, 4.89; p=0.014), and a largest metastatic tumor linear diameter ≥ 45 mm (HR, 5.48; p=0.017) were found to correlate with worse post-recurrence survival.
CONCLUSION
Risk factors could be used to classify uveal melanoma cases and subsequently direct individual treatment strategies. Furthermore, metastasectomy appears to contribute to improved survival outcomes.

Keyword

Uveal neoplasm; Melanoma; Recurrence; Survival; Prognosis; BAP1

MeSH Terms

Disease-Free Survival
Humans
Liver
Male
Melanoma*
Metastasectomy
Multivariate Analysis
Prognosis*
Radiotherapy
Recurrence
Risk Factors
Uveal Neoplasms

Figure

• 

  Fig. 1. Immunohistochemistry (IHC) analysis of primary uveal melanomas without (A) and with BRCA1 associated protein-1 (BAP1) expression (B) (×400). Analysis of recurrence-free survival (RFS, defined as the time from uveal melanoma diagnosis to recurrence) according to BAP1 expression (C). Analysis of overall survival from distant recurrence to death (OS2) according to BAP1 expression in metastatic tissues (D). CI, confidence interval; N/A, not available.

• 

  Fig. 2. Analysis of recurrence-free survival (RFS, defined as the time from choroidal melanoma diagnosis to recurrence) according to risk factors for recurrence of primary uveal melanoma (A). (B) Subgroup analysis according to local treatment with ≥ 1 risk factor. CI, confidence interval; N/A, not available. a)Includes tumor basal diameter ≥ 15 mm, depth ≥ 10 mm, b)Includes brachytherapy, gamma-knife radiotherapy, transpupillary thermotherapy, c)Includes trans pars plana vitrectomy, enucleation, excision, exentration.

• 

  Fig. 3. Analysis of overall survival from distant recurrence to death (OS2) according to survival-related risk factors in patients with metastatic uveal melanoma (A). (B) Subgroup analysis of high-risk patients (≥ 2 risk factors) according to systemic therapy or supportive care. (C) Subgroup analysis of low-risk patients (≤ 1 risk factor) according to the type of systemic treatment. CI, confidence interval. a)Includes male sex, largest linear dimension of largest metastatic tumor ≥ 45 mm, recurrence-free survival < 50 months.

Reference

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