GEP prognostication of posterior uveal melanoma: Does size matter?
Affiliations
- Department of Ophthalmology & Visual Sciences, University of Iowa, Iowa City, IA, 52242, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Affiliations
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Affiliations
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Affiliations
- Department of Ophthalmology & Visual Sciences, University of Iowa, Iowa City, IA, 52242, USA
Affiliations
- Department of Ophthalmology & Visual Sciences, University of Iowa, Iowa City, IA, 52242, USA
Affiliations
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Correspondence
- Corresponding Author: Arun D. Singh, MD Cole Eye Institute, Cleveland Clinic 9500 Euclid Avenue, Cleveland, Ohio 44195, USA Phone: (216) 445-9479
Correspondence information about the author Arun D. SinghAffiliations
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Correspondence
- Corresponding Author: Arun D. Singh, MD Cole Eye Institute, Cleveland Clinic 9500 Euclid Avenue, Cleveland, Ohio 44195, USA Phone: (216) 445-9479
Article Info
To view the full text, please login as a subscribed user or purchase a subscription. Click here to view the full text on ScienceDirect.
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.
To access this article, please choose from the options below
Purchase access to this article
Claim Access
If you are a current subscriber with Society Membership or an Account Number, claim your access now.
Subscribe to this title
Purchase a subscription to gain access to this and all other articles in this journal.
Institutional Access
Visit ScienceDirect to see if you have access via your institution.
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
Related Articles
Searching for related articles..
