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Hagström A, Witzenhausen H, Stålhammar G. Tailoring surveillance imaging in uveal melanoma based on individual metastatic risk. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00240-0. [PMID: 39151896 DOI: 10.1016/j.jcjo.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To develop surveillance programs for uveal melanoma patients, tailored to metastatic risk. METHODS Surveillance schedules were developed using the number needed to scan (NNS) concept, based on weighted average metastasis-free survival (MFS) rates from systematic review data of 18 prognostic groups (Disomy 3 (D3), Monosomy 3 (M3), EIF1AX-mutation, SF3B1-mutation, BAP1-mutation, high or low nBAP-1 immunohistochemistry, gene expression profiling classes (1;1A;1B;1PRAME-;1PRAME+;2;2PRAME-;2PRAME+), and V stages I-III). RESULTS In a typical surveillance schedule, involving biannual examinations years 1-5 and annual examinations years 6-10, the NNS varies dramatically from 1 to nearly infinity, underscoring the necessity for personalized surveillance approaches. On the basis of MFS data from 12 articles (n = 8046) and the targeted NNS level, the first surveillance examination under our model is recommended from 3 months to 5 years postdiagnosis. Specifically, the NNS 20 strategy requires an average of 10 examinations (SD 7), with D3 patients needing only two examinations (at 2- and 5-years' postdiagnosis), while those in GEP class 2PRAME+ require up to 17 examinations, scheduled between year 1 and 8. Under an NNS 20 protocol, we anticipate that 1-2% of examinations will lead to the use of effective treatments for metastatic disease, such as tebentafusp. The study presents customized surveillance schedules for all prognostic groups across various NNS levels, accompanied by a methodology for adapting surveillance to any desired NNS target. CONCLUSION Customizing uveal melanoma surveillance to match metastatic risks could transform current practices, ensuring more precise protocols, reducing unnecessary examinations, and directing health care resources to those in greatest need.
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Affiliation(s)
- Anna Hagström
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Hans Witzenhausen
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden; Ocular Oncology Service and St. Erik Ophthalmic Pathology Laboratory, St. Erik Eye Hospital, Stockholm, Sweden.
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2
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Lamas-Francis D, Rodríguez-Fernández CA, de Esteban-Maciñeira E, Silva-Rodríguez P, Pardo M, Bande-Rodríguez M, Blanco-Teijeiro MJ. Impact of Driver Mutations on Metastasis-Free Survival in Uveal Melanoma: A Meta-Analysis. Cancers (Basel) 2024; 16:2510. [PMID: 39061150 PMCID: PMC11274588 DOI: 10.3390/cancers16142510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The prognosis of uveal melanoma is significantly influenced by the risk of metastasis, which varies according to clinical and genetic features. Driver mutations can predict the likelihood of disease progression and survival, although the data in the literature are inconsistent. This meta-analysis aimed to evaluate the prognostic significance of driver mutations, including GNAQ, GNA11, BAP1, and SF3B1, in the advancement of uveal melanoma. A comprehensive search of databases yielded relevant studies, and data from 13 studies (848 eyes) were synthesized to assess the impact of these mutations on metastasis-free survival. The BAP1 mutation and negative immunohistochemistry were associated with a higher risk of metastasis (logHR = 1.44, 95% CI 1.05-1.83). GNAQ, GNA11, and SF3B1 mutations did not show a significant increase in risk. In summary, BAP1 has proven to reliably predict the likelihood of disease progression in uveal melanoma, while further studies are needed to establish the significance of other driver mutations.
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Affiliation(s)
- David Lamas-Francis
- Department of Ophthalmology, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Carmen Antía Rodríguez-Fernández
- Department of Ophthalmology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- FarmaChusLab Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Elia de Esteban-Maciñeira
- Department of Ophthalmology, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Paula Silva-Rodríguez
- Fundación Pública Galega de Medicina Xenómica, 15706 Santiago de Compostela, Spain
- Translational Ophthalmology Group, Health Research of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - María Pardo
- Obesidomics Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Manuel Bande-Rodríguez
- Department of Ophthalmology, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - María José Blanco-Teijeiro
- Department of Ophthalmology, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
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3
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Lai YS, Shatriah I, Lo YL, Koh KL, Kogilavaani J. A Choroidal Melanoma With Ciliary Body Involvement in a Young Female. Cureus 2024; 16:e56955. [PMID: 38665711 PMCID: PMC11044094 DOI: 10.7759/cureus.56955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Choroidal melanoma with ciliary body involvement is rare, especially in young adults and Asians. Here, we report the case of a young, healthy Chinese woman who complained of decreased vision in the left eye for one week. Her ocular examination and imaging were suggestive of choroidal melanoma involving the ciliary body. The patient underwent enucleation of the left eye. Close monitoring was needed, as the involvement of the ciliary body in choroidal melanoma is associated with a high risk of metastasis.
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Affiliation(s)
- Yen Sheong Lai
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
- Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
| | - Ismail Shatriah
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Yee Lin Lo
- Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
| | - Koon Ling Koh
- Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
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4
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Liu X, Yue H, Jiang S, Kong L, Xu Y, Chen Y, Wang C, Wang Y, Zhu X, Kong Y, Zhang X, Qian J, Luo Z. Clinical features and prognosis of patients with metastatic ocular and orbital melanoma: A bi-institutional study. Cancer Med 2023; 12:16163-16172. [PMID: 37409486 PMCID: PMC10469730 DOI: 10.1002/cam4.6273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/14/2023] [Accepted: 05/06/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE Metastatic ocular and orbital melanomas are extremely rare. The clinical characteristics and standard treatments for these patients are not fully established. MATERIALS AND METHODS We retrospectively analyzed patients with metastatic ocular and orbital melanoma from Fudan University Shanghai Cancer Center and Eye & ENT Hospital of Fudan University between January 2012 and May 2022. RESULTS Overall, 51 patients with metastatic ocular and orbital melanoma were included. The most common primary sites were uvea (73%), followed by conjunctiva (22%), lacrimal sac (4%), and orbit (2%). Patients with uveal melanoma (UM) had a significantly younger age (48 vs. 68 years, p < 0.001), higher incidence of liver metastases (89% vs. 9%, p<0.001), a lower incidence of lymph nodes metastases (16% vs. 46%, p = 0.043) and a lower incidence of BRAF mutation (0% vs. 55%, p<0.001) compared with patients with conjunctival melanoma (CM). The overall response rate of the first-line treatment was 18%. Three of the four patients with BRAF-mutated CM responded to dabrafenib and trametinib treatment. The median progression-free survival (PFS) and overall survival (OS) of first-line treatment were 5.1 and 11.9 months, respectively. Among patients with liver metastases, liver-directed treatment was correlated with better patient PFS (p < 0.001) and OS (p < 0.001) after adjusting for number of metastatic sites and primary sites. CONCLUSION CM and UM have different characteristics. Patient with CM had a high incidence of BRAF mutation, and the treatment of BRAF and MEK inhibitors conferred clinical benefit. Liver directed therapies had a potential benefit in disease control in patients with liver metastases.
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Affiliation(s)
- Xin Liu
- Department of Head & Neck tumors and Neuroendocrine tumorsFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Han Yue
- Department of OphthalmologyEye & ENT Hospital of Fudan UniversityShanghaiChina
| | - Shiyu Jiang
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of LymphomaFudan University Shanghai Cancer CenterShanghaiChina
| | - Lin Kong
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghaiChina
- Shanghai Key Laboratory of radiation oncologyShanghaiChina
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina
| | - Yu Xu
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Yong Chen
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Chunmeng Wang
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Yan Wang
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Xiaoli Zhu
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Yunyi Kong
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Xiaowei Zhang
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of gastrointestinal medical oncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Jiang Qian
- Department of OphthalmologyEye & ENT Hospital of Fudan UniversityShanghaiChina
| | - Zhiguo Luo
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Department of gastrointestinal medical oncologyFudan University Shanghai Cancer CenterShanghaiChina
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5
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Chi H, Peng G, Yang J, Zhang J, Song G, Xie X, Strohmer DF, Lai G, Zhao S, Wang R, Yang F, Tian G. Machine learning to construct sphingolipid metabolism genes signature to characterize the immune landscape and prognosis of patients with uveal melanoma. Front Endocrinol (Lausanne) 2022; 13:1056310. [PMID: 36568076 PMCID: PMC9772281 DOI: 10.3389/fendo.2022.1056310] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Background Uveal melanoma (UVM) is the most common primary intraocular malignancy in adults and is highly metastatic, resulting in a poor patient prognosis. Sphingolipid metabolism plays an important role in tumor development, diagnosis, and prognosis. This study aimed to establish a reliable signature based on sphingolipid metabolism genes (SMGs), thus providing a new perspective for assessing immunotherapy response and prognosis in patients with UVM. Methods In this study, SMGs were used to classify UVM from the TCGA-UVM and GEO cohorts. Genes significantly associated with prognosis in UVM patients were screened using univariate cox regression analysis. The most significantly characterized genes were obtained by machine learning, and 4-SMGs prognosis signature was constructed by stepwise multifactorial cox. External validation was performed in the GSE84976 cohort. The level of immune infiltration of 4-SMGs in high- and low-risk patients was analyzed by platforms such as CIBERSORT. The prediction of 4-SMGs on immunotherapy and immune checkpoint blockade (ICB) response in UVM patients was assessed by ImmuCellAI and TIP portals. Results 4-SMGs were considered to be strongly associated with the prognosis of UVM and were good predictors of UVM prognosis. Multivariate analysis found that the model was an independent predictor of UVM, with patients in the low-risk group having higher overall survival than those in the high-risk group. The nomogram constructed from clinical characteristics and risk scores had good prognostic power. The high-risk group showed better results when receiving immunotherapy. Conclusions 4-SMGs signature and nomogram showed excellent predictive performance and provided a new perspective for assessing pre-immune efficacy, which will facilitate future precision immuno-oncology studies.
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Affiliation(s)
- Hao Chi
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Gaoge Peng
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Jinyan Yang
- School of Stomatology, Southwest Medical University, Luzhou, China
| | - Jinhao Zhang
- School of Stomatology, Southwest Medical University, Luzhou, China
| | - Guobin Song
- School of Stomatology, Southwest Medical University, Luzhou, China
| | - Xixi Xie
- School of Stomatology, Southwest Medical University, Luzhou, China
| | - Dorothee Franziska Strohmer
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Guichuan Lai
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Songyun Zhao
- Department of Neurosurgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Rui Wang
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Fang Yang
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Gang Tian
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Characteristics, Treatments, and Survival of Uveal Melanoma: A Comparison between Chinese and American Cohorts. Cancers (Basel) 2022; 14:cancers14163960. [PMID: 36010953 PMCID: PMC9406112 DOI: 10.3390/cancers14163960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary This retrospective comparative cohort study aimed to determine whether there were racial or national differences in UM, by comparing the demographic and clinical characteristics, such as tumor size, onset age, trend and proportion of treatment modalities, and overall survival. In the two cohorts, we found that Chinese patients have a younger onset age and a better survival rate. The survival advantage was likely secondary to younger onset age. In addition, a greater proportion of Chinese patients received brachytherapy as opposed to enucleation compared with American patients. This study was the first time comparing patients from different countries and races, which may help ophthalmologists better understand the clinical characteristics of the disease and suggests the importance of early diagnosis and treatment. Abstract Uveal melanoma (UM) is the most common intraocular malignant carcinoma. This study aimed to compare the clinical features, treatment modalities, and prognosis of UM patients in China with those in America over a 15-year period. In the study, 4088 American patients with primary UM from the Surveillance, Epidemiology, and End Results (SEER) database and 1508 Chinese patients from Tongren-ophthalmology Research Association of Clinical Evaluation (TRACE) were included. Univariable and multivariable analyses were performed to determine prognostic factors and propensity score matching (PSM) and sensitivity analyses were applied to adjust for confounders and identify independent prognostic factors. Chinese patients were diagnosed at a younger age (mean ± SD, 47.3 ± 12.5 years vs. 59.7 ± 14.8 years) and tumors at diagnosis were larger (diameter: 12.0 ± 3.54 mm vs. 11.3 ± 8.27 mm; thickness: 7.13 ± 3.28 mm vs. 4.91 ± 3.01 mm). Chinese patients were more likely to undergo brachytherapy than American patients. Chinese patients had better overall survival than American patients while no significant differences exhibited after adjusting for age through PSM. In conclusion, compared with American patients, Chinese patients had younger onset age, larger tumors at diagnosis and better prognosis, mainly because of their younger age.
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Yue H, Xu B, Gao J, Bi Y, Xue K, Guo J, Zhang R, Ren H, Yuan Y, Qian J. A Novel and Easy-to-Promote Prognostic Model for Patients With Uveal Melanoma. Front Oncol 2022; 12:879394. [PMID: 35719929 PMCID: PMC9201029 DOI: 10.3389/fonc.2022.879394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To establish an easy and widely applicable prognostic prediction model for uveal melanoma (UM) based on a Chinese population. Patients and Methods A total of 295 consecutive cases treated at the Eye & ENT Hospital of Fudan University were included as the primary cohort, and 256 cases were included in the validation cohorts from two external Caucasian databases. Clinicopathological data were collected retrospectively, and nomogram models were formulated based on multivariable analysis. The concordance index (C-index), AUC (area under the Receiver Operating Characteristic, ROC curve), and Brier score were calculated and compared. Results Based on the training cohort, a nomogram model was established with five relevant variables: age, tumor size, ciliary body involvement, non-spindle cell type and extra-scleral extension. The C-index was 0.737, the 3- and 5-year AUCs were 0.767 and 0.742, and the Brier scores for 3- and 5-year survival were 0.082 and 0.129, respectively, which showed superior prediction compared to that of the Tumor, Node and Metastasis staging system. The model also displayed good discrimination and calibration in the external validation cohorts. By risk stratification, patients could be divided into low- and high-risk groups, and the overall survival curves displayed significant differences in the training and validation cohorts. Conclusion Our nomogram model was simple and accurate at predicting the overall survival of patients with UM. It was established based on Asian patients and proved suitable for Caucasian patients; thus, it has a wide range of potential applications, especially for patients living in less medically developed countries and regions.
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Affiliation(s)
- Han Yue
- Department of Ophthalmology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Binbin Xu
- Department of Ophthalmology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Jian Gao
- Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
| | - Yingwen Bi
- Department of Pathology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
| | - Kang Xue
- Department of Ophthalmology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Jie Guo
- Department of Ophthalmology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Rui Zhang
- Department of Ophthalmology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Hui Ren
- Department of Ophthalmology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Yifei Yuan
- Department of Ophthalmology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Jiang Qian
- Department of Ophthalmology, Eye & Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
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Gallenga CE, Franco E, Adamo GG, Violanti SS, Tassinari P, Tognon M, Perri P. Genetic Basis and Molecular Mechanisms of Uveal Melanoma Metastasis: A Focus on Prognosis. Front Oncol 2022; 12:828112. [PMID: 35480119 PMCID: PMC9037634 DOI: 10.3389/fonc.2022.828112] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/25/2022] [Indexed: 12/21/2022] Open
Abstract
Uveal melanoma (UM) is the most frequently found primary intraocular tumor, although it accounts for only 5% of all melanomas. Despite novel systemic therapies, patient survival has remained poor. Indeed, almost half of UM patients develop metastases from micro-metastases which were undetectable at diagnosis. Genetic analysis is crucial for metastatic risk prediction, as well as for patient management and follow-up. Several prognostic parameters have been explored, including tumor location, basal dimension and thickness, histopathologic cell type, vascular mimicry patterns, and infiltrating lymphocytes. Herein, the Authors review the available literature concerning cytogenetic prognostic markers and biochemical pathways correlated to UM metastasis development.
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Affiliation(s)
| | - Elena Franco
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Ginevra Giovanna Adamo
- Department of Specialized Surgery, Section of Ophthalmology, Sant’Anna University Hospital, Ferrara, Italy
| | - Sara Silvia Violanti
- Department of Head and Neck, Section of Ophthalmology, San Paolo Hospital, Savona, Italy
| | - Paolo Tassinari
- Department of Specialized Surgery, Section of Ophthalmology, Sant’Anna University Hospital, Ferrara, Italy
| | - Mauro Tognon
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Perri
- Department of Neuroscience and Rehabilitation, Section of Ophthalmology, University of Ferrara, Ferrara, Italy
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Huang YY, Hou TY, Yu WK, Tsai CC, Kao SC, Hsu WM, Liu JL(C. The Clinical Feature and Treatment Outcome of Ocular Melanoma: A 34-Year Experience in a Tertiary Referral Center. Cancers (Basel) 2021; 13:cancers13235926. [PMID: 34885033 PMCID: PMC8657155 DOI: 10.3390/cancers13235926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Malignant melanoma can arise from melanocytes in various structures of the eye, orbit, and ocular adnexa. We reviewed the clinical features and long-term results of all subjects with histologically proved melanoma originating from any of the ocular and periocular structures in a tertiary referral center. Overall, 88 patients including 47 men were recruited. The tumor was primarily located in the uvea, followed by the conjunctiva, orbit, eyelid, and lacrimal sac. Patients with uveal melanoma were diagnosed at a relatively younger age (47.0 years), while those with orbital and eyelid melanomas were older at presentation (79.5 years and 78.5 years, respectively). The overall local recurrence rate was 9% at a median follow-up of 41.0 months, among which orbital and eyelid melanomas recurred most commonly. The overall mortality rate was 41% in a median duration of 27.2 months (IQR, 13-58 months) from diagnosis, with the highest for lacrimal sac melanoma, followed by melanoma of the orbit, uveal, conjunctiva, and eyelid. Despite prompt local control, the risk for metastasis and mortality was high. Therefore, efficient modalities for early diagnosis and treatment of ocular melanoma are necessary.
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Affiliation(s)
- Yu-Yun Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Tzu-Yu Hou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Wei-Kuang Yu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Chieh-Chih Tsai
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Correspondence: ; Tel.: +886-2-28-757-325
| | - Shu-Ching Kao
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Wen-Ming Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Department of Ophthalmology, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City 23561, Taiwan
| | - Jui-Ling (Catherine) Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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Tabuenca Del Barrio L, Nova-Camacho LM, Zubicoa Enériz A, Martínez de Espronceda Ezquerro I, Córdoba Iturriagagoitia A, Borque Rodríguez-Maimón E, García-Layana A. Prognostic Factor Utility of BAP1 Immunohistochemistry in Uveal Melanoma: A Single Center Study in Spain. Cancers (Basel) 2021; 13:cancers13215347. [PMID: 34771510 PMCID: PMC8582434 DOI: 10.3390/cancers13215347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary As uveal melanoma metastasis rates are still very high, the mechanisms by which it spreads need to be evaluated. Our research sought to determine which pathological and clinical features were correlated with the prognosis of uveal melanoma in a Spanish community. BAP1 (BRCA1-Associated Protein 1) gene mutation is one of the strongest predictors for metastasis in uveal melanoma. The BAP1 protein has a tumor suppressor function and the presence of the BAP1 protein can be shown using immunohistochemical staining. Our study showed that nuclear BAP1 immunostaining had a significant correlation with survival rate in our sample, and patients with a lack of nuclear BAP1 immunostaining should be considered high-risk and receive a close follow-up. This stain can be used as routine technique in the pathological examination of uveal melanoma. Abstract Even today, the mortality rate for uveal melanoma (UM) remains very high. In our research, we sought to determine which pathological and clinical features were correlated with the prognosis of UM. BAP1 (BRCA1-Associated Protein 1) gene mutation has been analyzed as one of the strongest predictors for metastasis in UM. The BAP1 gene codifies the BAP1 protein which has a tumor suppressor function. The presence of this protein can be determined by BAP1 immunohistochemical staining. Eighty-four uveal melanoma patients and forty enucleated eyeballs were examined. Metastasis was present in 24 patients. Nuclear BAP1 staining was low in 23 patients. The presence of a higher large basal diameter tumor (p < 0.001), tumor infiltrating lymphocytes (p = 0.020), and a lack of nuclear BAP1 immunostaining (p = 0.001) ocurred significantly more often in the metastatic group. Metastasis-free survival was lower in patients with low nuclear BAP1 staining (p = 0.003). In conclusion, to the best of our knowledge, this is the first time that BAP1 staining has been studied in uveal melanoma in a Spanish community. We believe that this technique should become routine in the pathological examination of uveal melanoma in order to allow adequate classification of patients and to establish an individual follow-up plan.
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Affiliation(s)
- Laura Tabuenca Del Barrio
- Complejo Hospitalario de Navarra, Department of Ophthalmology, Calle Irunlarrea s/n, 31008 Pam-plona, Spain; (A.Z.E.); (E.B.R.-M.)
- IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea s/n, 31008 Pamplona, Spain; (I.M.d.E.E.); (A.G.-L.)
- Correspondence:
| | - Luiz Miguel Nova-Camacho
- Complejo Hospitalario de Navarra, Department of Pathology, Calle Irunlarrea s/n, 31008 Pamplo-na, Spain; (L.M.N.-C.); (A.C.I.)
| | - Alicia Zubicoa Enériz
- Complejo Hospitalario de Navarra, Department of Ophthalmology, Calle Irunlarrea s/n, 31008 Pam-plona, Spain; (A.Z.E.); (E.B.R.-M.)
- IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea s/n, 31008 Pamplona, Spain; (I.M.d.E.E.); (A.G.-L.)
| | - Iñigo Martínez de Espronceda Ezquerro
- IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea s/n, 31008 Pamplona, Spain; (I.M.d.E.E.); (A.G.-L.)
- Complejo Hospitalario de Navarra, Department of Dermatology, Calle Irunlarrea s/n, 31008 Pamplo-na, Spain
| | - Alicia Córdoba Iturriagagoitia
- Complejo Hospitalario de Navarra, Department of Pathology, Calle Irunlarrea s/n, 31008 Pamplo-na, Spain; (L.M.N.-C.); (A.C.I.)
| | - Enrique Borque Rodríguez-Maimón
- Complejo Hospitalario de Navarra, Department of Ophthalmology, Calle Irunlarrea s/n, 31008 Pam-plona, Spain; (A.Z.E.); (E.B.R.-M.)
| | - Alfredo García-Layana
- IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea s/n, 31008 Pamplona, Spain; (I.M.d.E.E.); (A.G.-L.)
- Department of Ophthalmology, Clínica Universidad de Navarra, Avenida de Pio XII 36, 31008 Pam-plona, Spain
- Instituto de Salud Carlos III, 28029 Madrid, Spain
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Zeng Q, Yao Y, Zhao M. Development and validation of a nomogram to predict cancer-specific survival of uveal melanoma. BMC Ophthalmol 2021; 21:230. [PMID: 34030647 PMCID: PMC8147099 DOI: 10.1186/s12886-021-01968-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Uveal melanoma (UM) is a rare but aggressive cancer, which is the most common primary intraocular malignancy in adults. We aimed to develop and validate a competing risk nomogram to predict cancer-specific survival (CSS) of patients with UM, as well as compare its prognostic value with that of the American Joint Committee on Cancer (AJCC) staging system. METHODS Data of patients diagnosed with UM from 2010 to 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. We extracted and integrated significant prognostic factors based on competing risk regression to build a nomogram. The nomogram with an online prediction version was also created. The performance of the nomogram was evaluated using Harrell's concordance index (C-index) and calibration plots. Receiver operating characteristic (ROC) curve was carried out to estimate clinical applicability of the model. Improvements in the predictive accuracy of our new model compared with AJCC staging system were estimated by calculating the relative integrated discrimination improvement (IDI) and the net reclassification improvement (NRI). RESULTS A total of 839 eligible patients with primary UM were randomly assigned to a training cohort (588, 70%) and a validation cohort (251, 30%). Age, histological type, T stage and M stage were independent prognostic factors to predict CSS of UM and were incorporated in the nomogram. The calibration plots indicated that the 3- and 5-year CSS probabilities were consistent between the nomogram prediction and the actual observation. The C-index for this model was 0.778 (95% CI:0.756-0.800) and 0.786 (95% CI: 0.749-0.816) in the training cohort and validation cohort. Areas under the curve (AUCs) were 0.814, 0.771, and 0.792 in the training cohort, 0.788, 0.781 and 0.804 in the validation cohort, respectively. The NRI value in AJCC staging system was - 0.153 (95% CI -0.29 - - 0.041) for 3 years of follow-up and - 0.276 (95% CI -0.415 - - 0.132) for 5 years of follow-up. The IDI values for 3 and 5 years of follow-up in the AJCC staging system were - 0.021 (P = 0.076) and - 0.045 (P = 0.004), respectively. CONCLUSIONS We have developed and validated a competing risk nomogram to reliably predict cancer-specific survival of patients with UM. This convenient tool may be useful for evaluating cancer-specific prognosis.
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Affiliation(s)
- Qiaozhu Zeng
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, Xicheng District, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yuou Yao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, Xicheng District, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, Xicheng District, China.
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China.
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Manchegowda P, Singh AD, Shields C, Kaliki S, Shah P, Gopal L, Rishi P. Uveal Melanoma in Asians: A Review. Ocul Oncol Pathol 2021; 7:159-167. [PMID: 34307326 DOI: 10.1159/000512738] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/02/2020] [Indexed: 12/22/2022] Open
Abstract
Despite limited data, some differences in the clinical profile can be observed in Asian population when compared with presentation of uveal melanoma (UM) in white population. The incidence of UM is higher in Whites than in Asians. For the purpose of comparison with Asian population, data from North America, Europe, and Australia were considered as that of "white" population. The annual incidence of UM has been reported to be 5-6 cases/million in whites. The incidence in different parts of Asia is estimated at 0.2-0.6 per million. The age of presentation is around 40-55 years in Asians, which is younger when compared to that of whites (mean age of 58 years). At presentation, mean basal diameter of tumors in Asians is greater compared to whites but overall, medium-size tumors are most common. Clinical presentation is straightforward in majority of cases with retinal detachment, acute glaucoma, uveitis, cataract, or vitreous hemorrhage as common symptoms. Epithelioid cell-type variant carries the worst prognosis. Management options for choroidal melanoma include transpupillary thermotherapy, plaque radiotherapy, charged particle irradiation, local resection, enucleation, or orbital exenteration. Most commonly used modalities are enucleation and plaque radiotherapy.
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Affiliation(s)
- Pradeep Manchegowda
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Arun D Singh
- Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carol Shields
- Ocular Oncology Service, Wills Eye hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Swathi Kaliki
- LV Prasad Eye Institute, Ocular Oncology Service, The Operation Eyesight Universal Institute of Eye Cancer, Hyderabad, India
| | - Parag Shah
- Department of Pediatric Retina & Ocular Oncology, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Coimbatore, India
| | - Lingam Gopal
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Pukhraj Rishi
- Truhlsen Eye Institute, University of Nebraska Medical Centre, Omaha, Nebraska, USA
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Zhou N, Zhang R, Liu Y, Wei W. Clinical Characteristics of UM and Association of Metastasis of Uveal Melanoma with Congenital Oculocutaneous Melanosis in Asian Patients: Analysis of 1151 Consecutive Eyes. Ophthalmol Retina 2021; 5:1164-1172. [PMID: 33444806 DOI: 10.1016/j.oret.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To analyze the clinical characteristics of uveal melanoma (UM) and evaluate the relationship of congenital oculocutaneous melanosis (OCM) to the prognosis of Asian patients with UM. DESIGN Retrospective cohort study. PARTICIPANTS We included a total of 1151 Asian patients with UM who were managed at the Beijing Tongren Hospital from June 26, 2005, to July 27, 2020. METHODS I-125 plaque brachytherapy, local resection, thermotherapy, or enucleation. MAIN OUTCOME MEASURES Melanoma-related metastasis and death. RESULTS Of 1151 Asian patients with UM, congenital OCM was present in 23 (0.20%). The melanocytosis involved the conjunctiva (78%), sclera (74%), eyelid (70%), face (26%), forehead (2.2%), iris (0.87%), choroid (0.87%), and auricle (0.4%). Univariate analysis of Cox proportional hazards regression model showed that age, tumor thickness, largest tumor basal diameter, and ciliary body involvement were the risk factors for the poor prognosis of Asian patients with UM. By multivariable analysis, the only factor predictive of melanoma-related metastasis and death was the largest tumor basal diameter (hazard ratio [HR], 1.21 [1.11-1.33], P < .001; 1.17 [1.01-1.35], P = 0.033). Probability-of-censoring weighted (IPW) estimation was used to mitigate selection bias due to loss to follow-up. Probability-of-censoring weighted estimation revealed the largest tumor basal diameter and ciliary body involvement were associated with metastasis (HR, 1.29 [1.15-1.45], P < 0.001; HR, 2.64 [1.01-6.90], P < 0.048). During the median follow-up period of 53 (33-67) months, 2 patients with OCM (8.7%) developed melanoma-related metastasis. By using nested case-control design and matched with the factors of age, largest tumor basal diameter, tumor thickness, and ciliary body involvement, Kaplan-Meier survival analysis showed that UM combined with OCM did not increase the risk of melanoma-related metastasis and death (P = 0.68, log-rank test). CONCLUSIONS The prominent risk for metastasis from UM was the largest tumor basal diameter in Asian patients. Estimation of IPW revealed that the largest tumor basal diameter and ciliary body involvement were the risk factors for UM metastasis. Patients with UM combined with OCM had a similar risk for metastasis compared with those with no OCM.
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Affiliation(s)
- Nan Zhou
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ruiheng Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yueming Liu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wenbin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Liu J, Lu J, Li W. A Comprehensive Prognostic and Immunological Analysis of a Six-Gene Signature Associated With Glycolysis and Immune Response in Uveal Melanoma. Front Immunol 2021; 12:738068. [PMID: 34630418 PMCID: PMC8494389 DOI: 10.3389/fimmu.2021.738068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/02/2021] [Indexed: 02/05/2023] Open
Abstract
Uveal melanoma (UM) is a subtype of melanoma with poor prognosis. This study aimed to construct a new prognostic gene signature that can be used for survival prediction and risk stratification of UM patients. In this work, transcriptome data from the Molecular Signatures Database were used to identify the cancer hallmarks most relevant to the prognosis of UM patients. Weighted gene co-expression network, univariate least absolute contraction and selection operator (LASSO), and multivariate Cox regression analyses were used to construct the prognostic gene characteristics. Kaplan-Meier and receiver operating characteristic (ROC) curves were used to evaluate the survival predictive ability of the gene signature. The results showed that glycolysis and immune response were the main risk factors for overall survival (OS) in UM patients. Using univariate Cox regression analysis, 238 candidates related to the prognosis of UM patients were identified (p < 0.05). Using LASSO and multivariate Cox regression analyses, a six-gene signature including ARPC1B, BTBD6, GUSB, KRTCAP2, RHBDD3, and SLC39A4 was constructed. Kaplan-Meier analysis of the UM cohort in the training set showed that patients with higher risk scores had worse OS (HR = 2.61, p < 0.001). The time-dependent ROC (t-ROC) curve showed that the risk score had good predictive efficiency for UM patients in the training set (AUC > 0.9). Besides, t-ROC analysis showed that the predictive ability of risk scores was significantly higher than that of other clinicopathological characteristics. Univariate and multivariate Cox regression analyses showed that risk score was an independent risk factor for OS in UM patients. The prognostic value of risk scores was further verified in two external UM cohorts (GSE22138 and GSE84976). Two-factor survival analysis showed that UM patients with high hypoxia or immune response scores and high risk scores had the worst prognosis. Moreover, a nomogram based on the six-gene signature was established for clinical practice. In addition, risk scores were related to the immune infiltration profiles. Taken together, this study identified a new prognostic six-gene signature related to glycolysis and immune response. This six-gene signature can not only be used for survival prediction and risk stratification but also may be a potential therapeutic target for UM patients.
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Affiliation(s)
- Jun Liu
- Reproductive Medicine Center, Yue Bei People’s Hospital, Shantou University Medical College, Shaoguan, China
- Medical Research Center, Yue Bei People’s Hospital, Shantou University Medical College, Shaoguan, China
| | - Jianjun Lu
- Department of Medical Affairs, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wenli Li
- Reproductive Medicine Center, Yue Bei People’s Hospital, Shantou University Medical College, Shaoguan, China
- *Correspondence: Wenli Li,
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van Poppelen NM, de Bruyn DP, Bicer T, Verdijk R, Naus N, Mensink H, Paridaens D, de Klein A, Brosens E, Kiliҫ E. Genetics of Ocular Melanoma: Insights into Genetics, Inheritance and Testing. Int J Mol Sci 2020; 22:E336. [PMID: 33396957 PMCID: PMC7795687 DOI: 10.3390/ijms22010336] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 12/18/2022] Open
Abstract
Ocular melanoma consists of posterior uveal melanoma, iris melanoma and conjunctival melanoma. These malignancies derive from melanocytes in the uveal tract or conjunctiva. The genetic profiles of these different entities differ from each other. In uveal melanoma, GNAQ and GNA11 gene mutations are frequently found and prognosis is based on mutation status of BAP1, SF3B1 and EIF1AX genes. Iris melanoma, also originating from the uvea, has similarities to the genetic makeups of both posterior uveal melanoma (UM) and conjunctival melanoma since mutations in GNAQ and GNA11 are less common and genes involved in conjunctival melanoma such as BRAF have been described. The genetic spectrum of conjunctival melanoma, however, includes frequent mutations in the BRAF, NRAS and TERT promoter genes, which are found in cutaneous melanoma as well. The BRAF status of the tumor is not correlated to prognosis, whereas the TERT promoter gene mutations are. Clinical presentation, histopathological characteristics and copy number alterations are associated with survival in ocular melanoma. Tissue material is needed to classify ocular melanoma in the different subgroups, which creates a need for the use of noninvasive techniques to prognosticate patients who underwent eye preserving treatment.
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Affiliation(s)
- Natasha M. van Poppelen
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Daniël P. de Bruyn
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Tolga Bicer
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Ophthalmology, University of Health Sciences Diskapi Training and Research Hospital, Ankara 06330, Turkey
| | - Rob Verdijk
- Department of Pathology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Nicole Naus
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
| | - Hanneke Mensink
- Department of Ophthalmic Oncology, The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands;
| | - Dion Paridaens
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Ophthalmic Oncology, The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands;
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Emine Kiliҫ
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
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Visual outcomes of proton beam therapy for choroidal melanoma at a single institute in the Republic of Korea. PLoS One 2020; 15:e0242966. [PMID: 33264363 PMCID: PMC7710050 DOI: 10.1371/journal.pone.0242966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022] Open
Abstract
We evaluate the ocular effects of proton beam therapy (PBT) in a single institution, in Korea, and identify factors contributing to decreasing visual acuity (VA) after PBT. A total of 40 patients who received PBT for choroidal melanoma (2009‒2016) were reviewed. Dose fractionation was 60‒70 cobalt gray equivalents (CGEs) over five fractions. Complete ophthalmic examinations including funduscopy and ultrasonography were performed at baseline and at 3, 6, and 12 months after PBT, then annually thereafter. Only patients with at least 12 months follow-up were included. During the follow-up, consecutive best-corrected visual acuity (BCVA) changes were determined, and univariate and multivariate logistic regression analyses were performed to identify predictors for VA loss. The median follow-up duration was 32 months (range: 12‒82 months). The final BCVA of nine patients was > 20/40. The main cause of vision loss was intraocular bleeding, such as neovascular glaucoma or retinal hemorrhage. Vision loss was correlated with the tumor size, tumor distance to the optic disc or fovea, maculae receiving 30 CGEs, optic discs receiving 30 CGEs, and retinas receiving 30 CGEs. Approximately one-third of PBT-treated choroidal melanoma patients with good pretreatment BCVA maintained their VA. The patients who finally lost vision (VA < count fingers) usually experienced rapid declines in VA from 6‒12 months after PBT. Tumor size, tumor distance to the optic disc or fovea, volume of the macula, and optic discs or retinas receiving 30 CGEs affected the final VA.
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Tan LLY, Hong J, Goh WL, Chang EWY, Yang VS, Poon E, Somasundaram N, Farid M, Chan ASY, Chan JY. Clinical features and survival outcomes of ocular melanoma in a multi-ethnic Asian cohort. Sci Rep 2020; 10:16367. [PMID: 33004998 PMCID: PMC7529790 DOI: 10.1038/s41598-020-73534-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
Ocular melanomas are uncommon cancers in Southeast Asia unlike in the West. We conducted a retrospective review of patients (n = 44) with histologically-proven ocular melanoma within a multi-ethnic Asian cohort from Singapore. Clinicopathological features and relapse patterns were examined, and survival outcomes of interest included recurrence-free survival (RFS) and overall survival (OS). Survival analysis was performed using the Kaplan–Meier method and multivariable Cox proportional regression. The study cohort included 18 male and 26 female patients, with a median age of 52 years (range 8–78). Median follow-up was 154 months. For uveal melanomas (n = 29), the 5-year RFS and OS was 56.8% and 76.6%, respectively; whilst for conjunctival melanomas (n = 15), the 5-year RFS and OS was 30.1% and 68.8%, respectively. Fifteen patients (38.5%) eventually developed metastasis, following which the median survival was only 17 months. Multivariate analysis demonstrated that higher T stage was a significant independent predictor for both OS (HR 8.69, 95% CI 1.03 to 73.09, p = 0.047) and RFS (HR 11.62, 95% CI 2.45 to 55.00, p = 0.002). Smoking history was independently predictive of better RFS (HR 0.08, 95% CI 0.01 to 0.78, p = 0.030). In conclusion, our study demonstrates the poor ocular melanoma outcomes in Southeast Asians, highlighting the necessity for urgent research in this area of unmet clinical need.
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Affiliation(s)
- Laura Ling Ying Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiancheng Hong
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Wei Lin Goh
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Institute of Molecular and Cell Biology, Singapore, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore
| | - Anita Sook Yee Chan
- Translational Ophthalmic Pathology Platform, Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6, The Academia, Singapore, 169856, Singapore. .,Ocular Inflammation and Immunology Department, Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. .,Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
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Yue H, Meng FX, Qian J, Xu BB, Li G, Wu JH. Calpastatin participates in the regulation of cell migration in BAP1-deficient uveal melanoma cells. Int J Ophthalmol 2019; 12:1680-1687. [PMID: 31741854 DOI: 10.18240/ijo.2019.11.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022] Open
Abstract
AIM To detect how BRCA-associated protein 1 (BAP1) regulates cell migration in uveal melanoma (UM) cells. METHODS Wound healing and transwell assays were performed to detect UM cell migration abilities. Protein chip, immunoprecipitations and surface plasmon resonance analyses were applied to identify BAP1 protein partners. Western blot and calpain activity assays were used to test the expression and function of calpastatin (CAST). RESULTS CAST protein was confirmed as a new BAP1 protein partner, and loss of BAP1 reduced the expression and function of CAST in UM cells. The overexpression of CAST rescued the cell migration phenotype caused by BAP1 loss. CONCLUSION BAP1 interacts with CAST in UM cells, and CAST and its subsequent calpain pathway may mediate BAP1-related cell migration regulation.
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Affiliation(s)
- Han Yue
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200433, China
| | - Feng-Xi Meng
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200433, China
| | - Jiang Qian
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200433, China
| | - Bin-Bin Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200433, China
| | - Gang Li
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200433, China.,Experimental Research Center, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
| | - Ji-Hong Wu
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200433, China.,Experimental Research Center, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
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19
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Arnljots TS, Al-Sharbaty Z, Lardner E, All-Eriksson C, Seregard S, Stålhammar G. Tumour thickness, diameter, area or volume? The prognostic significance of conventional versus digital image analysis-based size estimation methods in uveal melanoma. Acta Ophthalmol 2018; 96:510-518. [PMID: 29338132 DOI: 10.1111/aos.13668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to compare conventional and novel size estimation methods' ability to predict survival in uveal melanoma (UM). METHODS The study was designed as a retrospective consecutive chart review of patients with UM, enucleated between the years 1984 and 1993. Area and volume were estimated based on the largest histopathological cross-section, the second centroid theorem of Pappus and digital image analysis, correlated to overall and relative survival. RESULTS Of 168 patients analysed, 20 (12%) of tumours were categorized as T1, 47 (28%) as T2, 67 (40%) as T3 and 19 (11%) as T4 (15 N/a). A total of 91 tumours with complete survival and measurement data were included and recategorized into small, medium and large volume groups. Increased separation of overall survival was seen compared with current American Joint Committee on Cancer T categories. Difference between the large and small volume groups was 8.6 years (p = 0.001), compared to a difference of 5.6 years (p = 0.091) between T1 and T4. Hazard ratio for all-cause mortality in the large versus small volume group was 2.6 compared to 1.9 for T4 versus T1. Relative survival rates for small, medium and large volumes were 62, 44 and 31% at 10 years, versus 50, 45, 56 and 0% for T1, T2, T3 and T4. CONCLUSION This study provides evidence that a novel UM volume estimation method might offer a practical and cost-efficient alternative to improve the prognostic value intrinsic to a tumour's size.
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Affiliation(s)
| | - Zaid Al-Sharbaty
- Ophthalmic Pathology and Oncology Service; St. Erik Eye Hospital Stockholm Sweden
| | - Emma Lardner
- Ophthalmic Pathology and Oncology Service; St. Erik Eye Hospital Stockholm Sweden
| | - Charlotta All-Eriksson
- Ophthalmic Pathology and Oncology Service; St. Erik Eye Hospital Stockholm Sweden
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Stefan Seregard
- Ophthalmic Pathology and Oncology Service; St. Erik Eye Hospital Stockholm Sweden
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Gustav Stålhammar
- Ophthalmic Pathology and Oncology Service; St. Erik Eye Hospital Stockholm Sweden
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
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20
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Szalai E, Wells JR, Ward L, Grossniklaus HE. Uveal Melanoma Nuclear BRCA1-Associated Protein-1 Immunoreactivity Is an Indicator of Metastasis. Ophthalmology 2017; 125:203-209. [PMID: 28823399 DOI: 10.1016/j.ophtha.2017.07.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/10/2017] [Accepted: 07/21/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine the BRCA1-associated protein-1 (BAP1) expression of primary uveal melanomas without and with metastasis, and to analyze the correlation between the BAP1 immunoreactivity of primary uveal melanoma and other clinicopathologic features. DESIGN Retrospective case series. PARTICIPANTS Forty patients with uveal melanoma (mean age, 57.98±14.75 years) were included in this analysis, of whom 20 had no metastatic disease and 20 had metastasis. METHODS Medical records and histology slides of patients with primary uveal melanoma treated by enucleation were reviewed. BAP1 expression was evaluated by immunohistochemical staining of formalin-fixed, paraffin-embedded sections. Immunoreactivity in the nucleus and cytoplasm were graded by estimating the percentage of primary tumor cells showing a positive staining of their nucleus or cytoplasm per 1 high-power field 200× (grades 0-3). MAIN OUTCOME MEASURES Tumor size, histologic features, nuclear and cytoplasmic BAP1 immunoreactivity grade, and patient outcome, including development of metastasis. RESULTS Significantly lower (P = 0.025) nuclear BAP1 immunoreactivity was observed in the metastatic melanoma group. Greater tumor thickness, basal diameter, and more advanced TNM stage were associated with an increased odds ratio of developing metastasis (P < 0.05). In addition, tumors with a higher proportion of cells expressing nuclear BAP1 had decreased odds of developing metastatic disease in a multivariate model (P = 0.042). Metastasis-free survival was significantly longer in patients with uveal melanoma with high nuclear BAP1 stain (P = 0.004). CONCLUSIONS Time to metastasis differs in patients with primary uveal melanoma with different grades of nuclear BAP1 immunoreactivity. Nuclear BAP1 stain is the only significant independent predictor of metastatic disease in this study. Our data support the role of BAP1 immunohistochemical staining of primary uveal melanoma to evaluate metastatic risk.
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Affiliation(s)
- Eszter Szalai
- Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Jill R Wells
- Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Hans E Grossniklaus
- Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Pathology, Emory University School of Medicine, Atlanta, Georgia.
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