title: Development and external validation of a prognostic nomogram for metastatic uveal melanoma.
abstract: BACKGROUND
  Approximately 50% of patients with uveal melanoma (UM) will develop metastatic disease, usually involving the liver. The outcome of metastatic UM (mUM) is generally poor and no standard therapy has been established. Additionally, clinicians lack a validated prognostic tool to evaluate these patients. The aim of this work was to develop a reliable prognostic nomogram for clinicians.
  
  
  METHODS
  Two cohorts of mUM patients, from Veneto Oncology Institute (IOV) (N=152) and Mayo Clinic (MC) (N=102), were analyzed to develop and externally validate, a prognostic nomogram.
  
  
  RESULTS
  The median survival of mUM was 17.2 months in the IOV cohort and 19.7 in the MC cohort. Percentage of liver involvement (HR 1.6), elevated levels of serum LDH (HR 1.6), and a WHO performance status=1 (HR 1.5) or 2-3 (HR 4.6) were associated with worse prognosis. Longer disease-free interval from diagnosis of UM to that of mUM conferred a survival advantage (HR 0.9). The nomogram had a concordance probability of 0.75 (SE .006) in the development dataset (IOV), and 0.80 (SE .009) in the external validation (MC). Nomogram predictions were well calibrated.
  
  
  CONCLUSIONS
  The nomogram, which includes percentage of liver involvement, LDH levels, WHO performance status and disease free-interval accurately predicts the prognosis of mUM and could be useful for decision-making and risk stratification for clinical trials.
authors.affiliation: Melanoma Oncology Unit, Veneto Region Oncology Research Institute (IOV-IRCCS), Padova, Italy; Department of Surgery, Oncology and Gastroenterology, Padova, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Valpione
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, US.
authors.forename: Justin C
authors.initials: JC
authors.lastname: Moser
authors.affiliation: GB Bietti Foundation-IRCCS, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Parrozzani
authors.affiliation: Department of Statistical Sciences, University of Padova, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bazzi
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Mansfield
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, Padova, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.affiliation: Melanoma Oncology Unit, Veneto Region Oncology Research Institute (IOV-IRCCS), Padova, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Pigozzo
authors.affiliation: Department of Statistical Sciences, University of Padova, Padova, Italy; Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Midena
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Svetomir N
authors.initials: SN
authors.lastname: Markovic
authors.affiliation: Interventional Radiology, Veneto Region Oncology Research Institute (IOV-IRCCS) Padova, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Aliberti
authors.affiliation: Sarcoma and Melanoma Unit, Veneto Region Oncology Research Institute (IOV-IRCCS) Padova, Italy.
authors.forename: Luca G
authors.initials: LG
authors.lastname: Campana
authors.affiliation: Melanoma Oncology Unit, Veneto Region Oncology Research Institute (IOV-IRCCS), Padova, Italy.
authors.forename: Vanna
authors.initials: V
authors.lastname: Chiarion-Sileni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D049451:Nomograms; D016019:Survival Analysis; D014604:Uveal Neoplasms / Q000473:pathology*