Metastasis-free survival outcomes of uveal melanoma based on The Cancer Genome Atlas classification in 1585 cases

Abstract

Background: Genetic testing for uveal melanoma and tumour size is important in prognostication.

Methods: A review of 1 585 patients with uveal melanoma who had cytogenetic testing and classification, according to The Cancer Genome Atlas (TCGA), was performed. Kaplan-Meier (KM) metastasis-free survival at 1-, 3-, 5-, and 10-years were explored.

Results: The findings revealed TCGA Group A (n = 781; 49%), Group B (n = 215; 14%), Group C (n = 329; 21%), or Group D (n = 260; 16%). The median patient age at diagnosis was 60 years, sex was male in 51%, and race was White in 95%. A comparison (TCGA Group A vs Group B vs Group C vs Group D) revealed a difference in median patient age at tumour diagnosis (59 vs 59 vs 63 vs 65 years; p < 0.01), and initial visual acuity (20/20-20/50: 80% vs 68% vs 69% vs 64%; p < 0.01). The median tumour thickness was 4 mm, and the median diameter was 12 mm. A comparison (TCGA Group A vs Group B vs Group C vs Group D) revealed differences in median tumour thickness (3 vs 5 vs 6 vs 7 mm; p < 0.01), tumour diameter (10 vs 13 vs 13 vs 16 mm; p < 0.01), distance to foveola (3 vs 3 vs 4 vs 5 mm; p < 0.01), and distance to optic disc (3 vs 4 vs 5 vs 4 mm; p < 0.01). The KM metastasis-free survival estimates (TCGA Group A vs Group B vs Group C vs Group D) revealed differences at 1 year, 3 years, 5 years, and 10 years (p < 0.01) for any metastasis and specific survival rates at 5 years (96% vs 86% vs 62% vs 37%; p < 0.01), and 10 years (93% vs 78% vs 50% vs not available; p < 0.01) significantly decreased from Group A to Group D. By multivariate analysis, the hazard ratio for metastasis-free survival revealed differences in Groups B vs A (3.67), Groups C vs B (5.73), and Groups D vs C (3.20) (p < 0.01), as well as differences per tumour thickness (1.06) and diameter (1.13) (p < 0.01).

Conclusions: Genetic prognostication for metastatic risk from uveal melanoma using TCGA in this large cohort revealed that increasing TCGA category reduced the rate for metastasis-free survival.