1.Prognostic Factors and Decision Tree for Long-Term Survival in Metastatic Uveal Melanoma.
Daniel LORENZO ; María OCHOA ; Josep Maria PIULATS ; Cristina GUTIÉRREZ ; Luis ARIAS ; Jaume CATALÀ ; María GRAU ; Judith PEÑAFIEL ; Estefanía COBOS ; Pere GARCIA-BRU ; Marcos Javier RUBIO ; Noel PADRÓN-PÉREZ ; Bruno DIAS ; Joan PERA ; Josep Maria CAMINAL
Cancer Research and Treatment 2018;50(4):1130-1139
PURPOSE: The purpose of this study was to demonstrate the existence of a bimodal survival pattern in metastatic uveal melanoma. Secondary aims were to identify the characteristics and prognostic factors associated with long-term survival and to develop a clinical decision tree. MATERIALS AND METHODS: The medical records of 99 metastatic uveal melanoma patients were retrospectively reviewed. Patients were classified as either short (≤ 12 months) or long-term survivors (> 12 months) based on a graphical interpretation of the survival curve after diagnosis of the first metastatic lesion. Ophthalmic and oncological characteristicswere assessed in both groups. RESULTS: Of the 99 patients, 62 (62.6%) were classified as short-term survivors, and 37 (37.4%) as long-term survivors. The multivariate analysis identified the following predictors of long-term survival: age ≤ 65 years (p=0.012) and unaltered serum lactate dehydrogenase levels (p=0.018); additionally, the size (smaller vs. larger) of the largest liver metastasis showed a trend towards significance (p=0.063). Based on the variables significantly associated with long-term survival, we developed a decision tree to facilitate clinical decision-making. CONCLUSION: The findings of this study demonstrate the existence of a bimodal survival pattern in patients with metastatic uveal melanoma. The presence of certain clinical characteristics at diagnosis of distant disease is associated with long-term survival. A decision tree was developed to facilitate clinical decision-making and to counsel patients about the expected course of disease.
Clinical Decision-Making
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Decision Trees*
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Diagnosis
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Humans
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L-Lactate Dehydrogenase
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Liver
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Medical Records
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Melanoma*
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Multivariate Analysis
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Neoplasm Metastasis
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Retrospective Studies
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Survivors