American Joint Committee on Cancer Classification of Uveal Melanoma (Anatomic Stage) Predicts Prognosis in 7,731 Patients: The 2013 Zimmerman Lecture

Carol L Shields; Swathi Kaliki; Minoru Furuta; Enzo Fulco; Carolina Alarcon; Jerry A Shields

doi:10.1016/j.ophtha.2015.01.026

American Joint Committee on Cancer Classification of Uveal Melanoma (Anatomic Stage) Predicts Prognosis in 7,731 Patients: The 2013 Zimmerman Lecture

Ophthalmology. 2015 Jun;122(6):1180-6. doi: 10.1016/j.ophtha.2015.01.026. Epub 2015 Mar 24.

Authors

Carol L Shields¹, Swathi Kaliki², Minoru Furuta², Enzo Fulco², Carolina Alarcon², Jerry A Shields²

Affiliations

¹ Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: carol.shields@shieldsoncology.com.
² Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.

PMID: 25813452
DOI: 10.1016/j.ophtha.2015.01.026

Abstract

Purpose: To analyze the clinical features and prognosis of posterior uveal melanoma based on the American Joint Committee on Cancer (AJCC) (7th edition) tumor staging.

Design: Retrospective interventional case series.

Participants: A total of 7731 patients.

Methods: Uveal melanoma management.

Main outcome measures: Melanoma-related metastasis and death.

Results: Of 7731 patients with posterior uveal (ciliary body and choroidal) melanoma, the AJCC tumor staging was stage I in 2767 (36%), stage II in 3735 (48%), stage III in 1220 (16%), and stage IV in 9 (<1%). Based on tumor staging (I, II, III, and IV), features that showed significant increase with tumor staging included age at presentation (57, 58, 60, 60 years) (P < 0.001), tumor base (8, 12, 17, 17 mm) (P < 0.001), tumor thickness (2.9, 6.0, 10.1, 10.2 mm) (P < 0.001), distance to optic disc (3, 5, 5, 5 mm) (P < 0.001), distance to foveola (3, 5, 5, 5 mm) (P < 0.001), mushroom configuration (6%, 24%, 34%, 33%) (P < 0.001), plateau configuration (3%, 4%, 7%, 11%) (P < 0.001), tumor pigmentation (48%, 53%, 69%, 78%) (P < 0.001), and extraocular extension (0%, 1%, 11%, 22%) (P < 0.001). After therapy, Kaplan-Meier estimates of metastasis at 1, 5, 10, and 20 years were <1%, 5%, 12%, and 20% for stage I, 2%; 17%, 29%, and 44% for stage II; 6%, 44%, 61%, and 73% for stage III, and 100% by 1 year for stage IV. Kaplan-Meier estimates of death at 1, 5, 10, and 20 years were <1%, 3%, 6%, and 8% for stage I; <1%, 9%, 15%, and 24% for stage II; 3%, 27%, 39%, and 53% for stage III, and 100% by 1 year for stage IV. Compared with stage I, the hazard ratio for metastasis/death was 3.1/3.1 for stage II and 9.3/10.1 for stage III.

Conclusions: Compared with uveal melanoma classified as AJCC stage I, the rate of metastasis/death was 3 times greater for stage II, 9 to 10 times greater for stage III, and further greater for stage IV. Early detection of posterior uveal melanoma, at a point when the tumor is small, can be lifesaving.

Publication types

Lecture
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Humans
Male
Medical Oncology / organization & administration
Melanoma / classification*
Melanoma / diagnosis*
Melanoma / mortality
Middle Aged
Neoplasm Staging
Prognosis
Retrospective Studies
Societies, Medical / organization & administration
Survival Rate
United States
Uveal Neoplasms / classification*
Uveal Neoplasms / diagnosis*
Uveal Neoplasms / mortality

Supplementary concepts

Uveal melanoma