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  • Metastasis-Free Survival in Uveal Melanoma

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, September 2022

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    Singh et al. set out to compare the pre­dicted metastasis-free survival (MFS) with the observed MFS in patients with uveal melanoma and with those reported in published studies. They also explored the association of tumor variables, including tumor size, with the MFS in patients predicted to be at high risk of metastasis. They found the observed MFS did not differ from and was potentially better than the predict­ed MFS, and they noted that incor­porating tumor size in the prediction model may enhance its accuracy.

    For this study, the authors evaluated 347 patients from two academic centers who underwent prognostic fine-needle aspiration biopsy at the time of their treatment for uveal melanoma. They extracted the patients’ predicted MFS from a commercially available gene expression profiling (GEP) test report. The observed MFS was defined as time to metastasis. Cox proportional hazards models were fit to identify tumor vari­ables impacting MFS in patients with class 2 tumors. The overall estimate of the published MFS was obtained by performing meta-analysis of data from published series.

    The patients’ mean age at diagnosis was 59.4 years. There were 150 class 1A tumors (43%), 76 class 1B tumors (22%), and 121 class 2 tumors (35%). Through a follow-up interval of 38 months (range, 19-57 months), 48 pa­tients developed metastatic disease; of these, five had class 1A, three had class 1B, and 40 had class 2 tumors.

    The MFS for patients with class 1 tumors was 93% at three years and 87% at five years. For those with class 2 tumors, the three- and five-year out­comes were 67% and 47%, respectively. In the meta-analysis of the published studies for patients with class 2 tumors, the three- and five-year MFS outcomes were 62% and 40%, respectively. When compared to the predicted outcomes reported by the developer of the GEP test, these outcomes were similar for class 1 tumors and significantly better for class 2 tumors. (According to the GEP developer, the predicted MFS for class 2 tumors is 50% and 28% at three and five years, respectively.)

    With regard to tumor size, within the group of patients with class 2 tu­mors, those who experienced metasta­sis had larger tumors, and an increasing tumor size was associated with in­creased hazard ratio (HR) of metastasis (HR, 1.16, 95% confidence interval, 1.06-1.27; p < .001). Incorporating tumor size in the prediction model may enhance its accuracy, the authors noted.

    The original article can be found here.