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K. Hendler, S. Frenkel, R. Baruch, I. Kaiserman, R. Folberg, I. Kalickman, V. Barak, J. Pe'er; Comparison of Serum Biomarkers and Liver Function Tests in the Early Diagnosis of Metastases From Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):54. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Liver function tests (LFTs) are used routinely in screening for liver metastases (LM) of uveal melanoma (UM). Serum biomarkers have been shown to be a promising tool in the early diagnosis of metastatic UM. We compare the levels of serum biomarkers with the levels of LFTs before and at the time of diagnosis of LM from UM.
Patients with UM were followed semi-annually. Abdominal ultrasonography (US) and liver function tests (LFTs) including alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, lactate dehydrogenase, and total bilirubin were used to detect UM metastases to the liver. Blood was drawn for levels of S-100, melanoma inhibitory activity, Osteopontin, and tissue polypeptide-specific antigen. The serum biomarkers were measured using ELISA. Diagnosis of liver metastasis was confirmed by computed tomography (CT) and biopsy. Results of serum marker levels before and at the time of diagnosis of metastases were compared with LFTs taken at the same time points. Trends were calculated even within the normal range, during at least one year prior to diagnosis of metastases.
Tumor marker values at the time of diagnosis of LM were available for 24 patients; among them, 20 had both LFT and tumor marker values from at least 6 months prior to the diagnosis of LM. At the time of diagnosis, 23 of 24 patients had at least one elevated serum marker, while only 7 of these had at least one elevated LFT (p<0.0001). Six months before diagnosis of metastasis, 4 patients had elevation of both LFTs and serum markers. A rising trend in LFTs was found in 8 of 20 patients, while upward trends for serum markers were found in 14 of 20 patients (p=0.1). A rise in both LFTs and serum markers occurred in 5 patients. Prior to diagnosis of metastases, in 19 of 24 patients serum markers became abnormal before the LFTs, while in only 4 patients were LFTs elevated first (p=0.0001).
Both LFTs and serum markers seem to rise before detection of LM by US. A rising trend was found more frequently in biomarkers than in LFTs. A significantly larger number of patients had abnormal markers prior to having abnormal LFTs. Upward trends of serum markers can assist in the early diagnosis of UM metastases.
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