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A prognostic model and staging for metastatic uveal melanoma
Author(s) -
Eskelin Sebastian,
Pyrhönen Seppo,
HahkaKemppinen Marjo,
Tuomaala Seppo,
Kivelä Tero
Publication year - 2003
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.11113
Subject(s) - medicine , confidence interval , proportional hazards model , chemotherapy , metastasis , asymptomatic , melanoma , stage (stratigraphy) , gastroenterology , elevated alkaline phosphatase , survival analysis , cancer , oncology , surgery , alkaline phosphatase , paleontology , biochemistry , chemistry , cancer research , biology , enzyme
BACKGROUND To identify factors that independently contribute to overall survival in Stage IVB uveal melanoma and to subcategorize by prognosis. METHODS Data of 91 consecutive patients who died of metastatic uveal melanoma in 1985–2000 were analyzed by Kaplan–Meier and Cox regression analysis. Main covariates were participation in annual review, symptoms, Karnofsky index, metastatic burden, liver function tests, and age. Time on chemotherapy was modeled as a confounder. A working formulation for staging patients according to predicted survival was designed. RESULTS Of the 91 patients, 85% underwent annual liver imaging and function tests, 63% were asymptomatic, and 73% received chemotherapy. The median survival period was 8.4 months (95% confidence interval [CI], 6.3–11.8). Karnofsky index, largest dimension of the largest metastasis, metastatic burden, serum transaminase, lactate dehydrogenase, and alkaline phosphatase (AP) levels, and time on chemotherapy were strongly ( P < 0.001) associated with survival. Symptoms ( P = 0.031) and regular review ( P = 0.081) were weakly associated with survival. Karnofsky index ( P = 0.013), the largest dimension of the largest metastasis ( P = 0.003), and serum AP level ( P = 0.042) retained independent significance, adjusting for time on chemotherapy. Predicted median survival calculated for relevant covariate combinations was divided into three periods (≥12 months vs. 6–11 months vs. < 6 months). Observed median survival for Stage IVBa was 14.9 months (95% CI, 11.7–21.3), for Stage IVBb 8.9 months (95% CI, 2.7–13.7), and for Stage IVBc 2.0 months (95% CI, 1.0–3.7). CONCLUSION The model and working formulation for categorization can be tested as an aid in patient counseling and as a tool in design and analysis of clinical trials. Cancer 2003;97:465–75. © 2003 American Cancer Society. DOI 10.1002/cncr.11113