Abstract
Objectives
To determine survival outcomes following enucleation for uveal melanoma. To compare these outcomes with the 8th edition AJCC classification and determine the influence of cytogenetics, using Fluorescent in situ Hybridisation (FISH), on survival. To determine whether failure to gain sufficient sample for cytogenetics using Fine Needle Aspiration Biopsy (FNAB) correlates with survival.
Subjects/Methods
All patients undergoing primary enucleation for uveal melanoma at Moorfields Eye Hospital between 2012 and 2015 were included. Clinical, pathological, cytological and survival data were analysed for all patients.
Results
In total, 155 subjects were included. Mean age at enucleation was 65.9 years (SD 14.13). 88 (56.8%) patients died at a mean of three (SD 1.9) years following enucleation. Of these, 52 (33.5%) died from metastatic melanoma, 16 (10.3%) from other causes and 20 (12.9%) causes of death were unknown. Cumulative incidence analysis demonstrated AJCC grade, chromosome 8q gain and monosomy three all predict metastatic mortality. The greatest 5-year mortality rate (62%, SD10.1%) was in those with both chromosome abnormalities and AJCC stage III (Stage IV patients excluded due to low numbers). Largest basal diameter and chromosome status, both independently (p = 0.02 and p < 0.001) predicted metastatic mortality on multivariable regression analysis. Those who had an insufficient sample of cells gained during FNAB (n = 16) had no different prognosis.
Conclusions
This study confirms, in this population, the poor survival of patients enucleated for uveal melanomas. It confirms the prognostic utility of adding AJCC grade to cytogenetic information. It demonstrates that the lack of sample in patients undergoing FNAB is not related to prognosis.
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Acknowledgements
We would like to acknowledge the significant contribution that Victoria Cohen made to this paper before her tragic death in December 2020.
Funding
SS and SG were funded by Global Challenges Research Fund and UK Research and Innovation through the Medical Research Council grant number MR/P027881/1.
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All the authors made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. All the authors were involved in drafting the work or revising it critically for important intellectual content. All the authors were involved in the final approval of the version to be published. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Negretti, G.S., Gurudas, S., Gallo, B. et al. Survival analysis following enucleation for uveal melanoma. Eye 36, 1669–1674 (2022). https://doi.org/10.1038/s41433-021-01710-y
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DOI: https://doi.org/10.1038/s41433-021-01710-y
