title: Prospective study of surveillance testing for metastasis in 100 high-risk uveal melanoma patients.
abstract: Despite advances in the local treatment of UM, half of patients develop metastases typically to the liver with poor survival. Microscopic complete surgical resection (R0) of liver metastases improves survival in high selected patients. Early identification of high-risk patients might allow detection of asymptomatic metastases, and increase R0 liver surgery rate. From October 2006 to December 2009, we conducted a prospective study to detect early minimal lesions with 6-monthly liver function tests (LFTs) and liver MRI in 100 high-risk patients. High risk was defined by primary tumor clinical or genomic criteria: thickness>8mm or diameter>15 mm, or extra-scleral extension, or monosomy 3 by FISH or aCGH. With a median follow-up of 49 months, the 5-year metastasis-free survival and overall survival were 47 and 33%, respectively. Of the 60 patients who became metastatic, 50 (83%) had exclusive liver metastasis. LFTs screening had no sufficient accurary, but biannual MRI showed high predictive value to detect metastasis and select patients eligible for curative surgery: 25/50 underwent laparotomy and among them, 8/25 (32%) had a R0 surgery. Median survival after metastasis was 14 months, mean survival reached 40 months in the R0 resected population. Six-monthly liver MRI screening is recommended in patients with large tumors or genomic high risk in order to detect early patient candidates to complete resection of liver metastases.
authors.affiliation: Department of medical oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France. Electronic address: sophie.piperno-neumann@curie.fr.
authors.forename: S
authors.initials: S
authors.lastname: Piperno-Neumann
authors.affiliation: Department of radiology and nuclear medicine, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Servois
authors.affiliation: Department of surgical oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Mariani
authors.affiliation: Department of biostatistics, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Plancher
authors.affiliation: Department of surgical oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Lévy-Gabriel
authors.affiliation: Department of surgical oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Lumbroso-Le Rouic
authors.affiliation: Department of genetics, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Couturier
authors.affiliation: Department of biostatistics, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Asselain
authors.affiliation: Department of surgical oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Desjardins
authors.affiliation: Department of surgical oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Cassoux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D059146:Metastasectomy / Q000379:methods; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014604:Uveal Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D055815:Young Adult; D000098943:Uveal Melanoma
keywords: Detection; Détection; Haut risque de métastase; High risk of metastasis; Imagerie par résonance nucléaire; Liver metastasis; Magnetic resonance imaging; Mélanome uvéal; Métastases hépatiques; Uveal melanoma