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. 2023 Oct 17;15(20):5025.
doi: 10.3390/cancers15205025.

Surveillance for Metastasis in High-Risk Uveal Melanoma Patients: Standard versus Enhanced Protocols

Yağmur Seda Yeşiltaş  1 , Emily C Zabor  2 , Jacquelyn Wrenn  1 , Zackery Oakey  3 , Arun D Singh  1
Affiliations

Surveillance for Metastasis in High-Risk Uveal Melanoma Patients: Standard versus Enhanced Protocols

Yağmur Seda Yeşiltaş et al. Cancers (Basel). .

Abstract

Purpose: to evaluate the effectiveness of enhanced surveillance protocols (EP) utilizing high frequency (HF) or enhanced modality (EM) compared to the standard protocol (SP) in detecting metastasis and determining their impact on overall survival (OS) in high-risk uveal melanoma (UM) patients.

Methods: A total of 87 consecutive patients with Class 2 (high risk) primary UM were enrolled, with negative baseline systemic staging. The patients underwent systemic surveillance with either SP (hepatic ultrasonography [US] every 6 months) or EP (either HF [US every 3 months] or EM [incorporation hepatic computed tomography/magnetic resonance imaging]) following informed discussion. The main outcome measures were largest diameter of largest hepatic metastasis (LDLM), number of hepatic metastatic lesions, time to detection of metastasis (TDM), and OS.

Results: This study revealed significant differences in LDLM between surveillance protocols, with the use of EP detecting smaller metastatic lesions (HF, EM, and SP were 1.5 cm, 1.6 cm, and 6.1 cm, respectively). Patients on the EM protocol had a lower 24-month cumulative incidence of >3 cm metastasis (3.5% EM vs. 39% SP; p = 0.021), while those on the HF protocol had a higher 24-month cumulative incidence of ≤3 cm metastasis compared to SP (31% HF vs. 10% SP; p = 0.017). Hazard of death following metastasis was significantly reduced in the EP (HR: 0.25; 95% CI: 0.07, 0.84), HF (HR: 0.23; 95% CI: 0.06, 0.84), and EM (HR: 0.11; 95% CI: 0.02, 0.5) groups compared to SP. However, TDM and OS did not significantly differ between protocols.

Conclusions: Enhanced surveillance protocols improved early detection of hepatic metastasis in UM patients but did not translate into a survival advantage in our study cohort. However, early detection of metastasis in patients receiving liver-directed therapies may lead to improved overall survival.

Keywords: liver metastasis; surveillance; survival; uveal melanoma.

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Conflict of interest statement

The authors declare no conflict of interest. They alone are responsible for the content and writing of this paper.

Figures

Figure 1
Figure 1
Swimmer plot depicting systemic surveillance from baseline systemic staging. Each line represents the overall survival time for the patient. The line colors denote whether the patient was classified as standard protocol (blue) or enhanced protocol (red). Each circle represents a scan, and they are colored by modality so that hepatic ultrasonography is green, computer tomography is orange, and magnetic resonance imaging is purple. Each red triangle represents a metastasis and each black box represents a death.
Figure 2
Figure 2
Overall survival and time to detection of metastasis. The median time to death (A) and to detection of metastasis (B) were 65 months and 36 months, respectively.
Figure 3
Figure 3
Overall survival and time to detection of metastasis by surveillance protocol. There were no significant differences in overall survival or time to detection of metastasis between standard protocol vs. enhanced protocol (A,D), standard protocol vs. high frequency protocol (B,E), and standard protocol vs. enhanced modality protocol (C,F).
See this image and copyright information in PMC

References

    1. Eskelin S., Pyrhonen S., Summanen P., Prause J.U., Kivela T. Screening for metastatic malignant melanoma of the uvea revisited. Cancer. 1999;85:1151–1159. doi: 10.1002/(SICI)1097-0142(19990301)85:5<1151::AID-CNCR20>3.0.CO;2-G. - DOI - PubMed
    1. Choudhary M.M., Gupta A., Bena J., Emch T., Singh A.D. Hepatic Ultrasonography for Surveillance in Patients with Uveal Melanoma. JAMA Ophthalmol. 2016;134:174–180. doi: 10.1001/jamaophthalmol.2015.4810. - DOI - PubMed
    1. Eskelin S., Pyrhonen S., Summanen P., Hahka-Kemppinen M., Kivela T. Tumor doubling times in metastatic malignant melanoma of the uvea: Tumor progression before and after treatment. Ophthalmology. 2000;107:1443–1449. doi: 10.1016/S0161-6420(00)00182-2. - DOI - PubMed
    1. Harbour J.W. A prognostic test to predict the risk of metastasis in uveal melanoma based on a 15-gene expression profile. Methods Mol Biol. 2014;1102:427–440. - PMC - PubMed
    1. Field M.G., Harbour J.W. Recent developments in prognostic and predictive testing in uveal melanoma. Curr. Opin. Ophthalmol. 2014;25:234–239. doi: 10.1097/ICU.0000000000000051. - DOI - PMC - PubMed