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Simple Summary  Patients with uveal melanoma develop metastases that almost always affect the liver. These liver metastases can have as different metastatic patterns. In this study we investigated the role of the mutation status of the primary tumor in this metastatic process. Mutations in  BAP1  or  SF3B1  did not correlate with a specific hepatic metastatic pattern, whereas chromosome 1p loss and 8p loss were much more frequent in the primary uveal melanomas of patients who eventually develop miliary metastases in comparison to patients who develop single solitary hepatic metastases. Future endeavors could focus on discovering additional (genetic) factors which influence the propagation and development of hepatic metastases in UM.    Abstract  This study reports the role played by the mutation status of Uveal Melanoma (UM) in relation to hepatic metastatic patterns as seen on imaging modalities. Radiological images were obtained from 123 patients treated at the Erasmus Medical Center Rotterdam or the Rotterdam Eye Hospital. Radiological images were derived from either computed tomography or magnetic resonance imaging. Hepatic metastatic patterns were classified by counting the number of metastases found in the liver. Miliary metastatic pattern (innumerable small metastases in the entire liver) was analyzed separately. Mutation status was determined in 85 patients. Median disease-free survival (DFS) and survival with metastases differed significantly between each of the metastatic patterns (respectively,  p  = 0.009,  p  < 0.001), both in favor of patients with less hepatic metastases. The mutation status of the primary tumor was not correlated with any hepatic tumor profiles ( p  = 0.296). Of the patients who had a solitary metastasis ( n  = 18), 11 originated from a primary  BAP1 -mutated tumors and one from a primary  SF3B1 -mutated tumor. Of the patients who had a miliary metastasis pattern ( n  = 24), 17 had a primary  BAP1 -mutated tumor and two had a primary  SF3B1 -mutated tumor. Chromosome 8p loss was significantly more in patients with more metastases ( p  = 0.045). Moreover, the primary UMs of patients with miliary metastases harbored more chromosome 8p and 1p loss, compared to patients with single solitary metastasis ( p  = 0.035 and  p  = 0.026, respectively). In conclusion, our study shows that there is an inverse correlation of the number of metastasis with the DFS and metastasized survival, indicating separate growth patterns. We also revealed that the number and type of metastases is irrelevant to the prognostic mutation status of the tumor, showing that both  BAP1 - and  SF3B1 -mutated UM can result in solitary and miliary metastases, indicating that other processes lay ground to the different metastatic patterns.

Radiological Patterns of Uveal Melanoma Liver Metastases in Correlation to Genetic Status