Prognoses and Clinical Outcomes of Primary and Recurrent Uveal Melanoma
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Purpose Uveal melanoma has a very poor prognosis despite successful local primary tumor treatment. In this study, we investigated prognostic factors that more accurately reflected the likelihood of recurrence and survival and delineated a prognostic model that could effectively identify different risk groups based on initial clinical parameters. Materials and Methods Prognostic factors associated with distant recurrence, recurrence-free survival (RFS), progression- free survival, and overall survival from distant recurrence to death (OS2) were analyzed in 226 patients with stage I-III uveal melanoma who underwent primary local therapy. Results Forty-nine patients (21.7%) had distant recurrences, which occurred most frequently in the liver (87.7%). In a multivariate analysis, local radiotherapy improved RFS among patients with multiple recurrence risk factors relative to excision (not reached vs. 19.0 months, p=0.004). Patients with BRCA1-associated protein-1 (BAP1)negative primary tumors showed a longer RFS duration after primary treatments, while those with BAP1-negative metastatic tissues had a shorter OS2 compared to those with BAP1-positive tumors, both not statistically insignificance (RFS: not reached vs. 82.0 months, p=0.258; OS2: 15.7 vs. 24.4 months, p=0.216). Male sex (hazard ratio [HR], 3.79; p=0.012), a short RFS (HR, 4.89; p=0.014), and a largest metastatic tumor linear diameter 45 mm (HR, 5.48; p=0.017) were found to correlate with worse post-recurrence survival. Conclusion Risk factors could be used to classify uveal melanoma cases and subsequently direct individual treatment strategies. Furthermore, metastasectomy appears to contribute to improved survival outcomes.
Abstract
Purpose Uveal melanoma has a very poor prognosis despite successful local primary tumor treatment. In this study, we investigated prognostic factors that more accurately reflected the likelihood of recurrence and survival and delineated a prognostic model that could effectively identify different risk groups based on initial clinical parameters. Materials and Methods Prognostic factors associated with distant recurrence, recurrence-free survival (RFS), progression- free survival, and overall survival from distant recurrence to death (OS2) were analyzed in 226 patients with stage I-III uveal melanoma who underwent primary local therapy. Results Forty-nine patients (21.7%) had distant recurrences, which occurred most frequently in the liver (87.7%). In a multivariate analysis, local radiotherapy improved RFS among patients with multiple recurrence risk factors relative to excision (not reached vs. 19.0 months, p=0.004). Patients with BRCA1-associated protein-1 (BAP1)negative primary tumors showed a longer RFS duration after primary treatments, while those with BAP1-negative metastatic tissues had a shorter OS2 compared to those with BAP1-positive tumors, both not statistically insignificance (RFS: not reached vs. 82.0 months, p=0.258; OS2: 15.7 vs. 24.4 months, p=0.216). Male sex (hazard ratio [HR], 3.79; p=0.012), a short RFS (HR, 4.89; p=0.014), and a largest metastatic tumor linear diameter 45 mm (HR, 5.48; p=0.017) were found to correlate with worse post-recurrence survival. Conclusion Risk factors could be used to classify uveal melanoma cases and subsequently direct individual treatment strategies. Furthermore, metastasectomy appears to contribute to improved survival outcomes.
참고문헌 (29)
- Augsburger JJ, "Survival following enucleation versus plaque radiotherapy in statistically matched subgroups of patients with choroidal melanomas: results in patients treated between 1980 and 1987", Graefes Arch Clin Exp Ophthalmol, 237, pp.558~567 (1999)
- Kujala E, "Very long-term prognosis of patients with malignant uveal melanoma", Invest Ophthalmol Vis Sci, 44, pp.4651~4659 (2003)
- Singh AD, "Uveal melanoma: trends in incidence, treatment, and survival", Ophthalmology, 118, pp.1881~1885 (2011)
- Koutsandrea C, "Metastasis rates and sites after treatment for choroidal melanoma by proton beam irradiation or by enucleation", Clin Ophthalmol, 2, pp.989~995 (2008)
- Yamazaki N, "Phase 1b study of pembrolizumab (MK-3475;anti-PD-1 monoclonal antibody) in Japanese patients with advanced melanoma (KEYNOTE-041)", Cancer Chemother Pharmacol, 79, pp.651~660 (2017)
- Kottschade LA, "The use of pembrolizumab for the treatment of metastatic uveal melanoma", Melanoma Res, 26, pp.300~303 (2016)
- Harbour JW, "Frequent mutation of BAP1 in metastasizing uveal melanomas", Science, 330, pp.1410~1413 (2010)
- Koopmans AE, "Clinical significance of immunohistochemistry for detection of BAP1 mutations in uveal melanoma", Mod Pathol, 27, pp.1321~1330 (2014)
- Khattak MA, "Ipilimumab activity in advanced uveal melanoma", Melanoma Res, 23, pp.79~81 (2013)
- AJCC Ophthalmic Oncology Task Force, "International Validation of the American Joint Committee on Cancer's 7th edition classification of uveal melanoma", JAMA Ophthalmol, 133, pp.376~383 (2015)
- Kwon HJ, "Prognosis of choroidal melanoma and the result of ruthenium brachytherapy combined with transpupillary thermotherapy in Korean patients", Br J Ophthalmol, 97, pp.653~658 (2013)
- Lee JH, "Association between choroidal thickness and metabolic activity on positron emission tomography in eyes with choroidal melanoma", Am J Ophthalmol, 160, pp.1111~1115 (2015)
- Damato BE, "Surgical resection of choroidal melanoma;Retina", pp.762~772 (2001), Mosby
- Foulds WS, "Local resection versus enucleation in the management of choroidal melanoma", Eye (Lond), 1, pp.676~679 (1987)
- Damato B, "Endoresection of choroidal melanoma", Br J Ophthalmol, 82, pp.213~218 (1998)
- Buder K, "Systemic treatment of metastatic uveal melanoma: review of literature and future perspectives", Cancer Med, 2, pp.674~686 (2013)
- Liu YC, "Mortality from uveal melanoma treated by enucleation: a 16-year survey in Taiwan", Acta Ophthalmol, 91, pp.e583~e584 (2013)
- Murali R, "Tumours associated with BAP1 mutations", Pathology, 45, pp.116~126 (2013)
- Rietschel P, "Variates of survival in metastatic uveal melanoma", J Clin Oncol, 23, pp.8076~8080 (2005)
- Collaborative Ocular Melanoma Study Group, "Assessment of metastatic disease status at death in 435 patients with large choroidal melanoma in the Collaborative Ocular Melanoma Study (COMS): COMS report no. 15", Arch Ophthalmol, 119, pp.670~676 (2001)
- Kath R, "Prognosis and treatment of disseminated uveal melanoma", Cancer, 72, pp.2219~2223 (1993)
- Bedikian AY, "Treatment of uveal melanoma metastatic to the liver: a review of the M. D. Anderson Cancer Center experience and prognostic factors", Cancer, 76, pp.1665~1670 (1995)
- Pyrhonen S, "The treatment of metastatic uveal melanoma", Eur J Cancer, 34(Suppl 3), pp.S27~S30 (1998)
- Collaborative Ocular Melanoma Study Group, "COMS Manual of Procedures (1999). NTIS accession No. PB95-179693" (1999)
- Hicks C, "Predictive power of screening tests for metastasis in uveal melanoma", Eye (Lond), 12, pp.945~948 (1998)
- Gragoudas ES, "Survival of patients with metastases from uveal melanoma", Ophthalmology, 98, pp.383~389 (1991)
- Diener-West M, "Screening for metastasis from choroidal melanoma: the Collaborative Ocular Melanoma Study Group Report 23", J Clin Oncol, 22, pp.2438~2444 (2004)
- Augsburger JJ, "Effectiveness of treatments for metastatic uveal melanoma", Am J Ophthalmol, 148, pp.119~127 (2009)
- van Essen TH, "Prognostic parameters in uveal melanoma and their association with BAP1 expression", Br J Ophthalmol, 98, pp.1738~1743 (2014)