Ophthalmology. 2023 Oct 27:S0161-6420(23)00795-9. doi: 10.1016/j.ophtha.2023.10.026. Online ahead of print.
ABSTRACT
PURPOSE: The current, 8th Edition, of the American Joint Committee on Cancer (AJCC) anatomic classification and staging model for uveal melanoma does not fully separate survival estimates for patients in advanced stages of the disease (e.g., IIIB and IIIC). Furthermore, some tumors in higher size categories have a smaller volume than tumors in lower categories. Therefore, we develop a novel model for prognostication of metastatic mortality based on estimations of tumor volume.
DESIGN: Retrospective multicenter case series of patients with uveal melanoma involving the choroid and/or ciliary body.
SUBJECTS: Six thousand five hundred and twenty-eight consecutively registered patients treated at three tertiary ocular oncology centers on two continents between 1981 and 2022.
METHODS: Data on survival, tumor size, and extent were collected from all 6528 patients. Tumor volume was estimated using a simple equation based on largest basal diameter and thickness. Volume-based size categories and stages were developed and validated in independent patient cohorts using competing risk analyses, and correlations with cytogenetic and cytomorphological features were examined.
MAIN OUTCOME MEASURE: Cumulative incidence of metastatic death.
RESULTS: The 6528 patients were distributed over seven stages based on estimated tumor volume and anatomic extent (V-stages IA, IB, IIA, IIB, IIIA, IIIB, and IIIC), with a 15-year incidence of metastatic death ranging from 7 to 77 %. A new category, V1min, and corresponding stage IA, were introduced, indicating an excellent prognosis. Metastatic mortality in V-stage IIIC was significantly higher than that in V-stage IIIB (P=0.03), while incidence curves crossed for patients in AJCC stage IIIC vs. IIIB (P=0.53). Uni- and multivariate competing risk regressions demonstrated higher Wald statistics for V-stages compared to AJCC stages (1152 vs. 1038; and 71 vs. 17, respectively). The frequency of monosomy 3, gain of chromosome 8q, and epithelioid cytomorphology increased with tumor volume (R2 0.70, 0.50, and 0.71, respectively. P<0.001) and showed similar correlations with both AJCC and V-stages.
CONCLUSIONS: Anatomic classification and staging of ciliary body and choroidal melanomas based on estimation of tumor volume improves prognostication of metastatic mortality.
PMID:38071620 | DOI:10.1016/j.ophtha.2023.10.026
