Prognostic factors of liver metastases from uveal melanoma
This study was designed to assess survival and identify prognostic factors for liver metastases diagnosed by systematic screening in uveal melanoma patients.
Among 602 consecutive patients treated over 10 years for uveal melanoma and followed by systematic semi-annual hepatic screening (abdominal ultrasonography), 63 (10.5%) developed liver metastases; these patients form the basis of this study. Factors including patient demographics, characteristics of the uveal tumor, metastasis-free interval, severity of liver metastatic involvement, and treatments of metastases were studied retrospectively regarding their prognostic value, using univariate (Kaplan-Meier method) and multivariate (Cox model) analyses.
Thirty-five patients (55.6% of the metastatic population) received systemic chemotherapy or best supportive care only; 14 patients (22.2% of the metastatic population) diagnosed with diffuse liver involvement had cytoreductive surgery and intra-arterial chemotherapy; 14 (22.2% of the metastatic population) had complete surgical removal of liver metastases followed by postoperative intra-arterial chemotherapy. No significant surgical complications were experienced. The median overall survival after diagnosis of liver metastases was 15 months. It reached 25 months for selected patients with complete resection (P=0.0002). In this cohort of 63 patients, ten or fewer preoperatively diagnosed metastases and primary uveal melanoma not involving the ciliary body were independently associated with better prognosis.
This study suggests that selected patients with screened liver metastases from uveal melanoma may benefit from aggressive treatment, including surgery. The two independent favorable prognostic factors are fewer than ten metastases at screening and the absence of ciliary body involvement.
KeywordsUveal melanoma Liver metastasis Surgical treatment Prognostic factors
- 4.Cox D (1972) Regression models and life-tables (with discussions). J R Statist Soc Series B 34:187–220Google Scholar
- 16.McLean IW, Foster WD, Zimmerman LE (1977) Prognostic factors in small malignant melanomas of choroid and ciliary body. Arch Ophtalmol 95:48–58Google Scholar
- 29.Shields J, Shields C (1992) Introduction to melanocytic tumors of the uvea. In: Shields J, Shields C (eds) Intraocular tumors; a text and atlas. Williams & Wilkins, PhiladelphiaGoogle Scholar
- 31.Sobin L, Wittekind C (2002) TNM classification of malignant tumours. 6th ed. Wiley-Liss, GenèveGoogle Scholar
- 32.The Collaborative Ocular Melanoma Study (2001) Assessment of metastatic disease status at death in 435 patients with large choroidal melanoma in the Collaborative Ocular Melanoma Study (COMS): COMS report no. 15. Arch Ophthalmol 119:670–676Google Scholar
- 33.The Collaborative Ocular Melanoma Study Group (1997) Factors predictive of growth and treatment of small choroidal melanoma: COMS report no. 5. Arch Ophthalmol 115:1537–1544Google Scholar