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Patients presenting with metastases: stage IV uveal melanoma, an international study

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  • Gaurav Garg
  • Paul T Finger
  • Tero T Kivelä
  • E Rand Simpson
  • Brenda L Gallie
  • Svetlana Saakyan
  • Anush G Amiryan
  • Vladimir Valskiy
  • Kimberly J Chin
  • Ekaterina Semenova
  • Stefan Seregard
  • Maria Filì
  • Matthew Wilson
  • Barrett Haik
  • Josep Maria Caminal
  • Jaume Catala-Mora
  • Cristina Gutiérrez
  • David E Pelayes
  • Anibal Martin Folgar
  • Martine Johanna Jager
  • Mehmet Doğrusöz
  • Gregorius P M Luyten
  • Arun D Singh
  • Shigenobu Suzuki
  • AJCC Ophthalmic Oncology Task Force
  • Steffen Heegaard (Medlem af forfattergruppering)
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OBJECTIVE: To analyse ocular and systemic findings of patients presenting with systemic metastasis.

METHODS AND ANALYSIS: It is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases.

RESULTS: Of 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1-T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category.

CONCLUSIONS: Though higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.

TidsskriftThe British journal of ophthalmology
Udgave nummer4
Sider (fra-til)510-517
Antal sider8
StatusUdgivet - apr. 2022

Bibliografisk note

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

ID: 61987982