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Mrinali Patel, Corinne Winston, Brian P. Marr, Richard Carvajal, Gary Schwartz, Jedd Wolchok, Klaus Busam, David H. Abramson; Characterization Of Computerized Tomography (CT) Scan Abnormalities In Patients With Biopsy-proven Hepatic Metastases From Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3287.
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To describe the spectrum of computerized tomography (CT) features of patients with biopsy-proven hepatic metastases of uveal melanoma and to evaluate the prognostic value of the observed findings and their correlations to liver function tests.
The charts of consecutive patients with uveal melanoma evaluated at Memorial Sloan-Kettering Cancer Center between 1998 and 2009 were reviewed. Inclusion criteria included biopsy-proven liver metastasis and CT scan available within 2 months of biopsy. Exclusion criteria included prior systemic or liver-directed therapies for uveal melanoma. The charts and CT reports for patients in this study were retrospectively reviewed. Statistical analyses were carried out using Student’s t-test, Chi-squared analysis, and Kaplan Meier log-rank analysis, with a p-value of <0.05 taken to be significant.
Of the 505 charts that were reviewed, 76 patients met the inclusion and exclusion criteria defined above. Characteristic CT findings in this cohort of uveal melanoma patients with biopsy-proven liver metastases included multiple (89%), hypodense (100%), heterogenous (100%), and enhancing (100%) lesions with average dominant lesion size of 46.76 cm.2 Twenty three percent exhibited hepatomegaly. Predominant lesion size >100 cm2, hepatomegaly, and ascites correlated with worse survival (p = 0.0079, p<0.0001, and p<0.0001, respectively). Radiographic evidence of extrahepatic metastases was present in 53% of patients, most frequently in the lungs and lymph nodes, though a variety of atypical sites were also affected. In patients with hepatic metastases, the presence of additional extrahepatic metastases did not affect survival. At least one liver function test was abnormal in 69% of patients, and both elevation of one or both serum aminotransaminases and elevation of alkaline phosphatase were associated with larger lesions (p=0.0086 and p=0.0040, respectively) and hepatomegaly (p=0.0004 and p=0.0001, respectively). Bilirubin was elevated in only 33% of cases and did not correlate with lesion size or hepatomegaly.
We report that radiographic evidence of predominant lesion size >100 cm2, hepatomegaly, and ascites--but not radiographic evidence of extrahepatic metastases--correlate with worse survival in patients with biopsy-proven hepatic metastases of uveal melanoma.
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