Surveillance for Metastasis in High-Risk Uveal Melanoma Patients: Standard versus Enhanced Protocols

Yağmur Seda Yeşiltaş; Emily C Zabor; Jacquelyn Wrenn; Zackery Oakey; Arun D Singh

doi:10.3390/cancers15205025

Surveillance for Metastasis in High-Risk Uveal Melanoma Patients: Standard versus Enhanced Protocols

Cancers (Basel). 2023 Oct 17;15(20):5025. doi: 10.3390/cancers15205025.

Authors

Yağmur Seda Yeşiltaş¹, Emily C Zabor², Jacquelyn Wrenn¹, Zackery Oakey³, Arun D Singh¹

Affiliations

¹ Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, OH 44106, USA.
² Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA.
³ Blue Coast Retina, Hoag Memorial Hospital Presbyterian, Irvine, CA 92618, USA.

Abstract

Purpose: to evaluate the effectiveness of enhanced surveillance protocols (EP) utilizing high frequency (HF) or enhanced modality (EM) compared to the standard protocol (SP) in detecting metastasis and determining their impact on overall survival (OS) in high-risk uveal melanoma (UM) patients.

Methods: A total of 87 consecutive patients with Class 2 (high risk) primary UM were enrolled, with negative baseline systemic staging. The patients underwent systemic surveillance with either SP (hepatic ultrasonography [US] every 6 months) or EP (either HF [US every 3 months] or EM [incorporation hepatic computed tomography/magnetic resonance imaging]) following informed discussion. The main outcome measures were largest diameter of largest hepatic metastasis (LDLM), number of hepatic metastatic lesions, time to detection of metastasis (TDM), and OS.

Results: This study revealed significant differences in LDLM between surveillance protocols, with the use of EP detecting smaller metastatic lesions (HF, EM, and SP were 1.5 cm, 1.6 cm, and 6.1 cm, respectively). Patients on the EM protocol had a lower 24-month cumulative incidence of >3 cm metastasis (3.5% EM vs. 39% SP; p = 0.021), while those on the HF protocol had a higher 24-month cumulative incidence of ≤3 cm metastasis compared to SP (31% HF vs. 10% SP; p = 0.017). Hazard of death following metastasis was significantly reduced in the EP (HR: 0.25; 95% CI: 0.07, 0.84), HF (HR: 0.23; 95% CI: 0.06, 0.84), and EM (HR: 0.11; 95% CI: 0.02, 0.5) groups compared to SP. However, TDM and OS did not significantly differ between protocols.

Conclusions: Enhanced surveillance protocols improved early detection of hepatic metastasis in UM patients but did not translate into a survival advantage in our study cohort. However, early detection of metastasis in patients receiving liver-directed therapies may lead to improved overall survival.

Keywords: liver metastasis; surveillance; survival; uveal melanoma.

Grants and funding

This work was supported by a Research to Prevent Blindness Challenge Grant (Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine), Cole Family Endowment for Ophthalmic Oncology, and 2219-International Post-doctoral Research Scholarship Grant by The Scientific and Technological Research Council of Turkey (TUBITAK). The sponsor or funding organizations had no role in the design or conduct of this research.