During Friday’s Retina Subspeciality Day, Carol Shields, MD, provided an overview of uveal melanoma classifications and nonconditional and conditional survival. She described some recent studies that demonstrate how conditional survival, based on classifications from The Cancer Genome Atlas (TCGA), could help provide patients with hope.
The Cancer Genome Atlas. TCGA was established in 2006 to study 33 human cancers, including uveal melanoma. The project included multiplatform analysis of 80 cases of uveal melanoma. It led to the four basic categories of uveal melanoma: Groups A, B, C, and D.
In 2018, a study identified the molecular and clinical subsets of uveal melanoma based on a multiplatform molecular analysis and the monosomy and disomy of chromosome 3. The subsets increased in risk for metastatic disease: A and B are considered low risk, and C and D are considered high risk.
Nonconditional vs. conditional survival. “Nonconditional survival is what you all use. It’s static,” Dr. Shields told the audience. It is estimated from the date first seen to five or 10 years.
In contrast, “conditional survival is dynamic. It’s estimated for multiple dates,” she explained. Five-year outcomes can be estimated based on two-year survival; 10-year survival can be estimated by five-year survival.
Why does it matter? Last year, Dr. Shields and colleagues published a paper on nonconditional survival of patients according to the four TCGA groups. They found that, at 10 years, 6% of Group A patients, 20% of Group B, 46% of Group C, and 65% of Group D had metastatic disease.1 “So we have a basis, but a nonconditional basis, for outcomes,” she explained.
Inspired by a conditional survival study using the SEER database of more than 6,000 individuals,2 Dr. Shields and colleagues decided to look at conditional survival based on TCGA groups.
Looking at nonconditional analysis from time zero to 10 years, the researchers found that Group A had 94% survival, Group B had 80%, Group C had 50%, and Group D had 30%.3
With conditional survival, if the patient survived one or two years after uveal melanoma treatment, their 10-year outcomes continued to improve. For instance, the 10-year survival of patients in Group D improved from 32% to 38%, 50%, and 80% after surviving one, two, and five years, respectively, without metastasis.
According to TCGA group classifications, the longer a patient survives without metastatic disease, the lower their chance of developing metastasis.
“This is what the patient wants to know when they come in to see you,” Dr. Shields concluded. “This is practical, it’s dynamic. It provides hope for those people who live five years.” –Kanaga Rajan
1 Shields S et al. Indian J Ophthalmol. 2021;69(7):1839-1845.
2 Zabor E et al. Ophthalmol Retina. 2021;5(6):536-542.
3 Shields C et al. Saudi J Ophthalmol. 2021. doi:10.4103/SJOPT.SJOPT_69_21
Financial disclosures: Dr. Shields: Aura Biosciences Inc: C; Immunocore Inc: C.
Disclosure key: C = Consultant/Advisor; E = Employee; EE = Employee, executive role; EO = Owner of company; I = Independent contractor; L = Lecture fees/Speakers bureau; P = Patents/Royalty; PS = Equity/Stock holder, private corporation; S = Grant support; SO = Stock options, public or private corporation; US = Equity/Stock holder, public corporation For definitions of each category, see aao.org/eyenet/disclosures.
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