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James J Augsburger, Zelia M Correa; Prognostic Comparison of Tumor Size Classifications of Posterior Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5900.
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© ARVO (1962-2015); The Authors (2016-present)
To determine and compare the effectiveness of multiple published tumor size classifications of posterior melanomas as prognostic discriminators between small, medium, and large tumors.
Retrospective analysis of published classifications of posterior uveal melanoma [PUM] size (largest basal diameter [LBD] classification; rectangular area [LBD x thickness] classification; cubic volume [LBD x smallest basal diameter [SBD] x TH] classification; Warren classification; modified Warren classification; Gass classification; Augsburger classification; COMS original classification; COMS modified classification; TNM 2002 classification; TNM 2010 classification). 438 biopsy-confirmed PUMs encountered in our practice 9/2007 - 7/2015 were categorized as small, medium, or large by each of the evaluated classifications. A frequency distribution of small, medium and large tumors was computed for each classification, and a metastasis-free survival curve was computed for the patients having a primary intraocular tumor of the 3 size categories for each classification. The evaluated tumor size classifications were ranked from highest to lowest prognostic significance for emergence of metastasis with regard to the logrank test statistic associated with each classification.
The 438 patients ranged in age from 4 to 99 years (mean 61.9 yr, std. dev. 14.3 yr). The tumor was exclusively choroidal in 315 (71.9%) and involved the ciliary body in 123 (28.1%). The LBD of the tumor ranged from 5 to 24 mm (mean 12.2 mm, std. dev. 3.7 mm) and tumor thickness ranged from 1.5 to 18 mm (mean 5.7 mm, std. dev. 3.1 mm). The prognostic tumor size classifications were ranked as follows: (1) LBD classification; (2) TNM 2010 classification; (3) TNM 2002 classification; (4) modified Warren classification; (5) cubic volume classification; (6) Gass classification; (7) COMS revised classification; (8) COMS original classification; (9) Augsburger classification; (10) rectangular area classification; and (11) Warren original classification.
In this study, the TNM 2010 classification and LBD classification provided the best separation between prognostic subgroups. However, classifications that do not require reference to a size category boundaries graph for individual tumor size categorization (e.g., LBD classification, cubic volume classification) are much easier to use than ones that do (e.g., TNM and COMS classifications).
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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