Abstract
Purpose :
Gene expression profiling (GEP) of fine needle aspiration biopsies (FNAB) accurately predicts metastatic disease in uveal melanoma. We evaluated surveillance frequency and types of treatment for metastasis in patients who underwent GEP compared to a similar cohort who did not to determine if differences in disease management influence time to metastasis and survival.
Methods :
A retrospective study of patients treated with proton irradiation for choroidal melanoma was performed. Patients who underwent FNAB for GEP (DecisionDx-UM, Castle Biosciences) between 2013-2019 were identified. A control cohort of patients without GEP, matched 1:1 on AJCC classification, was assembled.
Results :
We identified 110 patients who underwent GEP and 110 patients who did not. Median age at ocular diagnosis was 59.8 years in the GEP group and 60.8 years in the group without GEP (p=0.39). Median follow-up time was 4.4 years (GEP) and 4.1 years (no GEP, p=0.70). The distribution of GEP class was 1A: 40%, 1B: 25%, 2: 35%.
In the GEP group, frequency of surveillance imaging increased with increased risk of metastasis by GEP classification (tests per year: 1.5, 1.7, 2.8 for tumor class 1A, 1B and 2, P=.0001). Patients with class 2 tumors were more likely to have MRIs than patients with class 1A and 1B tumors (90.9% v. 65.4% and 44,4%, P=.003). In the no GEP group, the frequency of surveillance was lower (1.6) in comparison to the GEP group (2.1).
The proportion of patients diagnosed with metastatic disease was 24% in the GEP group and 21% in the no GEP group (p=0.75). Survival after diagnosis of metastatic disease was 14.1 months in the GEP group and 8.5 months in the no GEP group (p=0.07). Survival from time of ocular diagnosis in patients who died of metastases was 3.1 years in the GEP group and 3.2 years in the no GEP group (p=0.60).
In the GEP group, 25 (96.2%) patients received treatment for metastasis compared to 18 (78.2%) in those without GEP (P=0.04) The most common first-line treatment was immunotherapy. Patients in the GEP group received more treatments than those without GEP (median: 3 and 2, P=0.09).
Conclusions :
There is a nonsignificant trend of longer survival after metastasis diagnosis and more treatments received for metastasis in patients with known GEP classification. Further exploration of the correlation between surveillance and treatment is needed to determine its impact on survival.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.