Patients presenting with metastases: stage IV uveal melanoma, an international study. Issue 4 (15th January 2021)

• Record Type: Journal Article
• Authors: Garg, Gaurav; Finger, Paul T; Kivelä, Tero T; Simpson, E Rand; Gallie, Brenda L; Saakyan, Svetlana; Amiryan, Anush G; Valskiy, Vladimir; Chin, Kimberly J; Semenova, Ekaterina; Seregard, Stefan; Filì, Maria; Wilson, Matthew; Haik, Barrett; Caminal, Josep Maria; Catala-Mora, Jaume; Gutiérrez, Cristina; Pelayes, David E; Folgar, Anibal Martin; Jager, Martine Johanna; Doğrusöz, Mehmet; Luyten, Gregorius P M; Singh, Arun D; Suzuki, Shigenobu
• Other Names: author non-byline.; Finger Paul T author non-byline.; Coupland Sarah E author non-byline.; Albert Daniel M author non-byline.; Amiryan Anush G author non-byline.; Saakyan Svetlana author non-byline.; Auw-Hädrich Claudia author non-byline.; Baker Diane author non-byline.; Barnhill Raymond author non-byline.; Caminal José M author non-byline.; Caroll William L author non-byline.; Cassoux Nathalie author non-byline.; Desjardins Laurence G author non-byline.; Pierron Gaelle author non-byline.; Catalá-Mora Jaume author non-byline.; Chantada Guillermo author non-byline.; Chévez-Barrios Patricia author non-byline.; Max Conway R author non-byline.; Damato Bertil E author non-byline.; Demirci Hakan author non-byline.; Dutton Jonathan J author non-byline.; Esmaeli Bita author non-byline.; Prieto Victor G author non-byline.; Williams Michelle author non-byline.; Gallie Brenda L author non-byline.; Graue Gerardo F author non-byline.; Grossniklaus Hans E author non-byline.; Heegaard Steffen author non-byline.; Holbach Leonard M author non-byline.; Honavar Santosh G author non-byline.; Jager Martine J author non-byline.; Kivelä Tero T author non-byline.; Kujala Emma author non-byline.; Rouic Livia Lumbroso-Le author non-byline.; Mallipatna Ashwin C author non-byline.; Modorati Giulio M author non-byline.; Munier Francis L author non-byline.; Murray Timothy G author non-byline.; Pavlick Anna C author non-byline.; Pe'er Jacob author non-byline.; Pelayes David E author non-byline.; Rodrigues Manuel author non-byline.; Sauerwein Wolfgang A G author non-byline.; Semenova Ekaterina author non-byline.; Seregard Stefan author non-byline.; Shields Carol author non-byline.; Rand Simpson E author non-byline.; Singh Arun D author non-byline.; Suzuki Shigenobu author non-byline.; Washington Mary Kay author non-byline.; White Valerie A author non-byline.; Wilson Mathew W author non-byline.; Wittekind Christian W author non-byline.; Yin Vivian author non-byline.;
• Is Part Of: British journal of ophthalmology. Volume 106:Issue 4(2022)
• Page Start: 510
• Page End: 517
• Publication Date: 2021-01-15
• Subjects: choroid -- ciliary body -- Iris -- retina -- imaging; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2020-317949
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : 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.