Characterization of Computed Tomography Scan Abnormalities in Patients With Biopsy-Proven Hepatic Metastases From Uveal Melanoma
ABSTRACT To describe the computed tomography (CT) features in patients with biopsy-proven hepatic metastases of uveal melanoma and correlate these findings with survival.
The medical records of patients with uveal melanoma evaluated at Memorial Sloan-Kettering Cancer Center from January 1998 to September 2009 were reviewed. Inclusion criteria were biopsy-proven liver metastasis and CT scan images available within 2 months of biopsy. Exclusion criteria were prior systemic or liver-directed therapy for uveal melanoma. Statistical analyses were carried out using the t test, χ(2) test, and Kaplan-Meier log-rank analyses.
Of 505 medical records reviewed, 76 were selected for study. Characteristic CT findings included multiple (68 patients [90%]), hypodense (100%), heterogeneous (100%), and enhancing (100%) hepatic lesions with a mean dominant lesion size of 46.8 cm(2). Eighteen patients (24%) exhibited hepatomegaly. Predominant lesion size larger than 100 cm(2), hepatomegaly, and ascites correlated with a lower survival rate (P = .008, P < .001, and P < .001, respectively). Radiographic evidence of extrahepatic metastases was present in 40 patients (53%). However, the presence of extrahepatic metastases did not affect survival. The results of at least 1 liver function test were abnormal in 46 of 67 patients (69%), and elevation of at least 1 serum transaminase and elevation of alkaline phosphatase were associated with larger lesions (P = .009 and P = .004, respectively) and hepatomegaly (P < .001 for both).
Radiographic evidence of predominant lesion size larger than 100 cm(2), hepatomegaly, and ascites-but not radiographic evidence of extrahepatic metastases-correlate with a lower survival rate in patients with biopsy-proven hepatic metastases of uveal melanoma.
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ABSTRACT: BACKGROUND/AIMS: To evaluate MRI in the detection of asymptomatic hepatic metastases from uveal melanoma. METHODS: A single-arm prospective cohort study. PARTICIPANTS: We enrolled 188 patients whose predicted 5-year mortality from uveal melanoma exceeded 50%. This prognostication was performed by multivariate analysis of clinical stage, histological grade and genetic type, using our online tool, based on Accelerated Failure Time modelling. These high-risk patients underwent a six-monthly assessment, which included history-taking, clinical examination, hepatic MRI (without contrast, unless suspicious lesions were identified) and biochemical liver function tests. RESULTS: Ninety (48%) of the 188 patients developed detectable metastases, a median of 18 months after ocular treatment. Six-monthly MRI-detected metastases before symptoms in 83 (92%) of 90 patients developing systemic disease, with 49% of these having less than five hepatic lesions all measuring less than 2 cm in diameter. Of these 90 patients, 12 (14%) underwent hepatic resection, all surviving for at least a year afterwards. CONCLUSIONS: Six-monthly MRI detects metastases from high-risk uveal melanoma before the onset of symptoms, enhancing any opportunities for early treatment of metastatic disease and clinical trial participation. Whether these actually result in prolongation of life, after taking lead-time bias into account, requires further investigation.The British journal of ophthalmology 11/2012; 97(2). DOI:10.1136/bjophthalmol-2012-302323 · 2.98 Impact Factor
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ABSTRACT: To determine the outcome of patients that underwent liver resection for metastases from uveal melanoma. Over a 9-year period, patients referred with uveal melanoma metastases were included. Following treatment of primary uveal melanoma, high-risk patients were offered to be enrolled into a 6-monthly non-contrast liver magnetic resonance imaging (MRI) surveillance. Following detection of liver metastases, patients were staged with a contrast-enhanced (Primovist®) liver MRI, computer tomography (CT) of the thorax and staging laparoscopy. 155 patients were referred with uveal melanoma liver metastases, of which 17 (11.0%) patients had liver resection and one patient was treated with percutaneous radio-frequency ablation. The majority of patients undergoing liver resection were treated with multiple metastectomies (n = 8) and three patients had major liver resections. The overall median survival for patients treated with surgery/ablation was 27 (14-90) months, and this was significantly better compared to patients treated palliatively [median = 8(1-30) months, P < 0.001]. Following surgery, 11 patients had recurrent disease [median = 13(6-36) months]. Patients who had undergone a major liver resection had a significantly poorer disease-free survival (P = 0.037). Patients who can undergo surgical resection for metastatic uveal melanoma have a more favorable survival compared to those who do not. J. Surg. Oncol. © 2013 Wiley Periodicals, Inc.Journal of Surgical Oncology 05/2014; 109(6). DOI:10.1002/jso.23535 · 3.24 Impact Factor