Prognoses and Clinical Outcomes of Primary and Recurrent Uveal Melanoma

Cancer Res Treat. 2018 Oct;50(4):1238-1251. doi: 10.4143/crt.2017.534. Epub 2017 Dec 28.

Abstract

Purpose: Uveal melanoma has a very poor prognosis despite successful local primary tumor treatment. In this study, we investigated prognostic factors that more accurately reflected the likelihood ofrecurrence and survival and delineated a prognostic model that could effectively identify different risk groups based on initial clinical parameters.

Materials and methods: Prognostic factors associated with distant recurrence, recurrence-free survival (RFS), progression-free survival, and overall survival from distant recurrence to death (OS2) were analyzed in 226 patients with stage I-III uveal melanoma who underwent primary local therapy.

Results: Forty-nine patients (21.7%) had distant recurrences, which occurred most frequently in the liver (87.7%). In a multivariate analysis, local radiotherapy improved RFS among patients with multiple recurrence risk factors relative to excision (not reached vs. 19.0 months, p=0.004). Patients with BRCA1-associated protein-1 (BAP1)‒negative primary tumors showed a longer RFS duration after primary treatments, while those with BAP1-negative metastatic tissues had a shorter OS2 compared to those with BAP1-positive tumors, both not statistically insignificance (RFS: not reached vs. 82.0 months, p=0.258; OS2: 15.7 vs. 24.4 months, p=0.216). Male sex (hazard ratio [HR], 3.79; p=0.012), a short RFS (HR, 4.89; p=0.014), and a largest metastatic tumor linear diameter ≥ 45 mm (HR, 5.48; p=0.017) were found to correlate with worse post-recurrence survival.

Conclusion: Risk factors could be used to classify uveal melanoma cases and subsequently direct individual treatment strategies. Furthermore, metastasectomy appears to contribute to improved survival outcomes.

Keywords: BAP1; Melanoma; Prognosis; Recurrence; Survival; Uveal neoplasm.

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Melanoma / metabolism
  • Melanoma / mortality
  • Melanoma / radiotherapy*
  • Middle Aged
  • Neoplasm Recurrence, Local / metabolism
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / radiotherapy*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Tumor Suppressor Proteins / metabolism*
  • Ubiquitin Thiolesterase / metabolism*
  • Uveal Neoplasms / metabolism
  • Uveal Neoplasms / mortality
  • Uveal Neoplasms / radiotherapy*
  • Young Adult

Substances

  • BAP1 protein, human
  • Tumor Suppressor Proteins
  • Ubiquitin Thiolesterase

Supplementary concepts

  • Uveal melanoma