Comparison ofthe PrognosticValue of Three Current Staging Systems for Uveal Melanoma

Abstract

Abstract: : Purpose: To compare the prognostic value of three staging systems for uveal melanoma. Methods: Retrospective review of 239 patients with uveal melanoma requiring treatment with radioactive iodine¹²⁵ plaque or enucleation from 1991 to 1999 by a single surgeon at the Bascom Palmer Eye Institute. All patients’ melanomas were staged according to three staging systems: the American Joint Committee on Cancer (AJCC) Tumor Node Metastases (TNM), the AJCC revised TNM, and the Collaborative Ocular Melanoma Study (COMS) clinical staging. All cause mortality, melanoma specific mortality and systemic metastasis were the endpoint outcome measures. Results: Of the 239 patients, 188 were alive at the conclusion of the follow–up window with an all–cause mortality of 78.7%. 35 of 239 patients (14.6 %) developed systemic metastases at or before the last follow–up window. 85.4% of patients had a metastasis–free survival. Mean follow up was 56.3 months. The COMS (p<0.001) and the revised TNM (p<0.001) systems were superior to the old TNM in predicting systemic metastasis (p=0.005) Conclusion: The COMS and revised TNM staging systems for uveal melanoma are at least equally effective at predicting disease progression to systemic metastasis as the old TNM system.

Keywords: uvea • melanoma • oncology