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Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma

SIMPLE SUMMARY: Uveal melanoma (UM) is an eye cancer that will spread to other parts of the body in almost 50% of cases, most commonly to the liver. Regular liver scans can lead to early detection of UM metastases. Current guidelines recommend such liver surveillance in UM patients with a ‘high risk...

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Autores principales: Robinson, Helena, Eleuteri, Antonio, Sacco, Joseph J., Hussain, Rumana, Heimann, Heinrich, Taktak, Azzam F. G., Damato, Bertil, Thompson, Alexander J., Allen, Thomas, Kalirai, Helen, Coupland, Sarah E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10177440/
https://www.ncbi.nlm.nih.gov/pubmed/37174076
http://dx.doi.org/10.3390/cancers15092610
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author Robinson, Helena
Eleuteri, Antonio
Sacco, Joseph J.
Hussain, Rumana
Heimann, Heinrich
Taktak, Azzam F. G.
Damato, Bertil
Thompson, Alexander J.
Allen, Thomas
Kalirai, Helen
Coupland, Sarah E.
author_facet Robinson, Helena
Eleuteri, Antonio
Sacco, Joseph J.
Hussain, Rumana
Heimann, Heinrich
Taktak, Azzam F. G.
Damato, Bertil
Thompson, Alexander J.
Allen, Thomas
Kalirai, Helen
Coupland, Sarah E.
author_sort Robinson, Helena
collection PubMed
description SIMPLE SUMMARY: Uveal melanoma (UM) is an eye cancer that will spread to other parts of the body in almost 50% of cases, most commonly to the liver. Regular liver scans can lead to early detection of UM metastases. Current guidelines recommend such liver surveillance in UM patients with a ‘high risk’ of metastasis but do not specify how this group is defined. Several different systems can estimate a patient’s risk of dying from metastatic UM. Our study compared the accuracy of different UM prognostic systems when used to target enrolment into surveillance programmes and suggests that some systems could relieve some patients from unnecessary scans and conserve resources. We found that using the Liverpool Uveal Melanoma Prognosticator Online III (LUMPOIII) could offer equal sensitivity and greater specificity than other systems. We suggest guidance for its use, even when genetic testing is not provided. This study provides important context for revising the clinical guidelines for stratification for surveillance in UM. ABSTRACT: Uveal melanoma (UM) metastasises in ~50% of patients, most frequently to the liver. Surveillance imaging can provide early detection of hepatic metastases; however, guidance regarding UM patient risk stratification for surveillance is unclear. This study compared sensitivity and specificity of four current prognostic systems, when used for risk stratification for surveillance, on patients treated at the Liverpool Ocular Oncology Centre (LOOC) between 2007–2016 (n = 1047). It found that the Liverpool Uveal Melanoma Prognosticator Online III (LUMPOIII) or Liverpool Parsimonious Model (LPM) offered greater specificity at equal levels of sensitivity than the American Joint Committee on Cancer (AJCC) system or monosomy 3 alone, and suggests guidance to achieve 95% sensitivity and 51% specificity (i.e., how to detect the same number of patients with metastases, while reducing the number of negative scans). For example, 180 scans could be safely avoided over 5 years in 200 patients using the most specific approach. LUMPOIII also offered high sensitivity and improved specificity over the AJCC in the absence of genetic information, making the result relevant to centres that do not perform genetic testing, or where such testing is inappropriate or fails. This study provides valuable information for clinical guidelines for risk stratification for surveillance in UM.
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spelling pubmed-101774402023-05-13 Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma Robinson, Helena Eleuteri, Antonio Sacco, Joseph J. Hussain, Rumana Heimann, Heinrich Taktak, Azzam F. G. Damato, Bertil Thompson, Alexander J. Allen, Thomas Kalirai, Helen Coupland, Sarah E. Cancers (Basel) Article SIMPLE SUMMARY: Uveal melanoma (UM) is an eye cancer that will spread to other parts of the body in almost 50% of cases, most commonly to the liver. Regular liver scans can lead to early detection of UM metastases. Current guidelines recommend such liver surveillance in UM patients with a ‘high risk’ of metastasis but do not specify how this group is defined. Several different systems can estimate a patient’s risk of dying from metastatic UM. Our study compared the accuracy of different UM prognostic systems when used to target enrolment into surveillance programmes and suggests that some systems could relieve some patients from unnecessary scans and conserve resources. We found that using the Liverpool Uveal Melanoma Prognosticator Online III (LUMPOIII) could offer equal sensitivity and greater specificity than other systems. We suggest guidance for its use, even when genetic testing is not provided. This study provides important context for revising the clinical guidelines for stratification for surveillance in UM. ABSTRACT: Uveal melanoma (UM) metastasises in ~50% of patients, most frequently to the liver. Surveillance imaging can provide early detection of hepatic metastases; however, guidance regarding UM patient risk stratification for surveillance is unclear. This study compared sensitivity and specificity of four current prognostic systems, when used for risk stratification for surveillance, on patients treated at the Liverpool Ocular Oncology Centre (LOOC) between 2007–2016 (n = 1047). It found that the Liverpool Uveal Melanoma Prognosticator Online III (LUMPOIII) or Liverpool Parsimonious Model (LPM) offered greater specificity at equal levels of sensitivity than the American Joint Committee on Cancer (AJCC) system or monosomy 3 alone, and suggests guidance to achieve 95% sensitivity and 51% specificity (i.e., how to detect the same number of patients with metastases, while reducing the number of negative scans). For example, 180 scans could be safely avoided over 5 years in 200 patients using the most specific approach. LUMPOIII also offered high sensitivity and improved specificity over the AJCC in the absence of genetic information, making the result relevant to centres that do not perform genetic testing, or where such testing is inappropriate or fails. This study provides valuable information for clinical guidelines for risk stratification for surveillance in UM. MDPI 2023-05-04 /pmc/articles/PMC10177440/ /pubmed/37174076 http://dx.doi.org/10.3390/cancers15092610 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Robinson, Helena
Eleuteri, Antonio
Sacco, Joseph J.
Hussain, Rumana
Heimann, Heinrich
Taktak, Azzam F. G.
Damato, Bertil
Thompson, Alexander J.
Allen, Thomas
Kalirai, Helen
Coupland, Sarah E.
Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma
title Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma
title_full Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma
title_fullStr Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma
title_full_unstemmed Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma
title_short Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma
title_sort sensitivity and specificity of different prognostic systems in guiding surveillance for metastases in uveal melanoma
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10177440/
https://www.ncbi.nlm.nih.gov/pubmed/37174076
http://dx.doi.org/10.3390/cancers15092610
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