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Scott Daniel Walter, Tahira Mahten, J William Harbour; Clinical Predictors of Survival after Hepatic Arterial Chemoembolization for Stage IV Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5098.
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© ARVO (1962-2015); The Authors (2016-present)
To determine factors predicting response to hepatic arterial chemoembolization (HACE) in patients with metastatic uveal melanoma.
A retrospective analysis of 37 patients who underwent HACE for metastatic uveal melanoma. Primary outcome measure was months from first HACE to death. Statistical analysis was performed using Cox proportional hazards analysis.
Factors associated with poor outcome following HACE included epithelioid cell type (HR 3.34, p=0.02) and ciliary body involvement in the primary tumor (HR 3.04, p=0.01). Factors associated with better outcome included nodular angiographic pattern of liver metastasis (HR 0.22, p<0.001), fewer than 10 liver metastases (HR 0.16, p=0.001), pre-treatment liver enzymes less than twice the upper limit of normal (alkaline phosphatase HR 0.42, p=0.05; alanine aminotransferase HR 0.17, p<0.001), and greater number of HACE treatments (HR 0.36, p<0.001). The use of Gelfoam drug-eluting particles was a significant predictor of longer survival, even after controlling for number of HACE treatments (HR 0.58, p=0.03).
HACE for metastatic uveal melanoma is most effective in patients with a nodular angiographic pattern, fewer than 10 liver metastases, and lower pre-treatment liver enzymes. HACE is more effective in treating metastatic uveal melanoma when combined with the use of drug-eluting Gelfoam particles.
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