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James J. Augsburger, Zelia M. Correa; Expected Long-term Survival Prognosis Of Posterior Uveal Melanoma Patients Whose Tumor Cells Exhibit Disomy 3 And/or Class 1 Gene Expression Profile. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1433.
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Patients having a primary posterior uveal melanoma whose tumor cells exhibit monosomy 3 and/or class 2 gene expression profile have been shown to be at high risk for development of metastasis that will lead to death within five years. In contrast, short-term studies indicate that patients whose tumor cells exhibit disomy 3 and/or class 1 gene expression profile (GEP) have a low 5-year risk of metastasis and metastatic death. Long-term survival prognosis of this latter subgroup of patients is currently unknown. The survival distribution of the combined subgroups of patients must equal the survival distribution of patients without known chromosomal or transcriptional status.
Hypothetical survival modeling of patients with primary uveal melanoma assuming two distinct survival distributions. Modeling attempted to predict the expected long-term survival of patients with disomy 3 and/or class 1 GEP by making the combined subgroups’ survival distribution mirror that of patients without known chromosomal or transcriptional status. Short-term survival curves for patients evaluated by chromosomal testing and/or GEP were obtained from recently published articles, and long-term survival curves for patients without known chromosomal or transcriptional status were obtained from published AFIP data.
Survival modeling predicted that approximately 15 to 25% of patients with primary choroidal or ciliary body melanoma whose tumor cells have been categorized by chromosomal testing or GEP as disomy 3 or class 1 cases will ultimately develop uveal melanoma metastasis; however, most of these patients will not exhibit this metastasis until more than 5 years after treatment of the primary intraocular tumor.
Current short-term predictions of survival prognosis of patients with uveal melanomas associated with disomy 3 and/or class 1 GEP are likely to be substantial underestimates of these patients’ long-term survival prognosis. Patients with such tumors should not be advised that their risk of developing future metastasis is extremely low. The authors will discuss potential explanations for early and late appearing metastasis in this subgroup of patients.
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