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Staging of uveal melanoma metastases
Author(s) -
KIVELÄ T,
ESKELIN S
Publication year - 2012
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.2875.x
Subject(s) - medicine , melanoma , stage (stratigraphy) , metastasis , cancer , oncology , lymph node , multivariate analysis , disease , radiology , elevated alkaline phosphatase , alkaline phosphatase , cancer research , paleontology , biochemistry , chemistry , biology , enzyme
Purpose To summarize the need and methods available to stage metastatic uveal melanoma. Methods Literature review and personal experience. Results In the Tumor, Node, Metastasis (TNM) classification, metastatic disease is assigned to category N1 (regional lymph node metastasis) and M1 (systemic metastasis) and stage IV by definition. For practical purposes, uveal melanoma spawns only systemic metastases. The latest 7th TNM edition, effective from January 2010, introduced subcategories of M1 based on the largest diameter of the largest metastasis (LDLM) at diagnosis of disseminated disease: M1a corresponds to LDLM 3.0 cm or less, M1b to LDLM 3.1‐8.0 cm and M1c to LDLM 8.1 mm or above. In addition to the TNM system, a staging system based on three variables: performance index as a measure of the general health of the patient, serum or plasma alkaline phosphatase level as a measure of the hepatic function and non‐measurable metastases and to LDLM as a measure of measurable metastases is available. It was developed at the Helsinki University Central Hospital and has been validated by the European Ophthalmic Oncology Group. An underlying multivariate model assigns patients into stages IVa, IVb and IVc with predicted median survival of less than 6 months, 6 to 12 months and over 12 months. In the validation data set, the corresponding observed median survival times were 18.6 months for stage IVa, 10.7 months for stage IVb, and 4.6 months for stage IVc. Conclusion Staging of cancer at diagnosis is important because it enables the physician to assess the extent of disease in a standardized way. This will help in choosing appropriate treatment and in assessing treatment outcomes between studies in a more comparable way.