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Figures

Figure 1

Kaplan-Meier survival curve for class 1 and class 2 patients. The three-year metastasis-free survival was 96% for class 1 patients and 63% for class 2 patients. The five-year metastasis-free survival was 96% for class 1 patients and 49% for class 2 patients.

Figure 2

Distribution of patients in each GEP class by AJCC, COMS, and LBD size classifications. There appeared to be a trend towards patients with GEP class 2 tumors being larger across all classification schemes. However, none of these differences were statistically significant.

Figure 3

Receiver Operating Characteristic (ROC) curve showing the ability to detect metastasis-free survival at 36 month based on GEP alone versus GEP with various tumor size measures. Incorporation of all size measures (AJCC stage, COMS size, tumor LBD, tumor thickness) improved the ability of the model to correctly identify higher risk cases (prognostic discrimination index) relative to the model with the GEP test alone.

Abstract

Purpose

To investigate the influence of tumor size by American Joint Committee on Cancer (AJCC) stage, Collaborative Ocular Melanoma Study (COMS) size, tumor largest basal diameter (LBD), and tumor thickness on prognostication by gene expression profiling (GEP) class.

Design

Two center, retrospective

Subjects: 215 consecutive patients diagnosed with posterior uveal melanoma over a five-year period who were evaluated with prognostic fine needle aspiration biopsy (FNAB) at the time of primary treatment.

Methods

Patient demographics, tumor clinical size, AJCC stage, COMS size, GEP class, presence of metastasis, and mortality data were collected. Metastasis-free-survival (MFS) was defined as time to metastasis or death from any cause. Comparisons were made using Pearson chi-square tests or Fisher exact tests for categorical factors, and t-tests or Kruskal-Wallis tests for continuous measures. Cox proportional hazards models were fit to identify whether size measurements increased the prognostic discrimination index (C-statistic).

Main Outcome Measures

Metastasis-free-survival

Results

The average follow-up interval was 22.0 months [12.0, 37.0]. Eighty-nine tumors were class 1A, 48 class 1B, and 78 class 2. Twenty-one patients developed metastatic disease detected by surveillance and confirmed by liver biopsy. Three-year MFS was 96% for class 1 and 63% for class 2. Five-year MFS was 96% for class 1 and 49% for class 2. All size measures significantly improved prognostic discrimination index by GEP class as shown by increase in the C-statistic with addition of size variables (C-statistic 0.750 for GEP alone, 0.830 GEP with AJCC (p=0.016), 0.822 GEP with COMS (p<0.001), 0.842 GEP with LBD (p<0.001), and 0.847 GEP with tumor thickness (p<0.001)). Class 2 patients with metastasis had larger tumors compared to non-metastatic class 2 tumors (AJCC class p=0.004; COMS class p=0.024; with metastasis mean thickness 6.5 mm [3.8, 9.5], without metastasis 3.9 mm [3.1, 6.0] (p=0.008), with metastasis mean LBD 14.9±2.8 mm, without metastasis, 12.3±2.7 mm p<0.001). All class 1 tumors with metastasis were large requiring enucleation.

Conclusions

Incorporation of tumor size enhances the prognostic discrimination index of the GEP test in patients with posterior uveal melanoma. All size tumor parameters are equivalent in their ability to enhance GEP prognostication.

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Meeting presentation: This work was presented at the American Academy of Ophthalmology meeting in San Francisco CA, October 2019

Financial Support: None

Conflict of interest: No conflicting relationship exists for any author

 

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