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Raffaele Parrozzani, Sara Valpione, Vanna Chiarion-Sileni, Olympia Kotsafti, Edoardo Midena; Metastatic Uveal Melanoma: a Prognostic Model and Nomogram. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5097.
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© ARVO (1962-2015); The Authors (2016-present)
The aim of this study was to identify independent prognostic factors to formulate a prognostic nomogram to treat metastatic uveal melanoma patients
Prospectively recorded data of 141 patients with metastatic uveal melanoma, who received different therapy (loco-regional hepatic treatments, systemic therapy, both or no treatment) as first-line approach, were retrospectively analysed. Metastatic disease was confirmed by biopsy or fine needle aspiration cytology. The characteristics of primary uveal melanoma, the site and time of detection of metastases, the type and outcome of therapies, the time of last follow-up or death, and the cause of death were included. Data were analysed with a Cox regression model to identify prognostic factors that may influence final outcome.
The median age at detection of primary uveal melanoma was 61.5 years (range, 25.3-82.5 years); metastatic disease was detected at median age of 63.6 years (range, 34.3-83.0 years) and median survival from metastasis detection was 18.5 months (range, 1.2-86.4 months). The most frequent first metastatic site was liver (79%). Patients received loco-regional hepatic treatments (12.1%), systemic therapy (39.7%), both (33.3%) or no treatment (14.9%). Liver substitution entity (hazard ratio (HR) 1.3), multiple organ involvement (HR 2.0), increasing levels of serum lactate dehydrogenases(LDH) (HR 1.8) and WHO performance status = 1 (HR 1.6) or 2-3 (HR 4.7) were associated with worse prognosis. Long disease-free interval (HR 0.9) and loco-regional treatment for liver metastases (HR 0.5) conferred a survival advantage (22.6 months) compared to systemic therapies alone (13.4 months) (p=0.038). A nomogram to predict death probability within 6, 12 and 24 months was developed (C-index=0.74).
Life prognosis of metastatic uveal melanoma depends on the percentage of liver involvement, spread to multiple organs, serum LDH, performance status, disease-free interval and loco-regional treatment.
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