External Validation of the Liverpool Uveal Melanoma Prognosticator Online

Abstract

PURPOSE. To validate the Liverpool Uveal Melanoma Prognosticator Online (LUMPO) in a cohort of patients treated at the University of California-San Francisco (UCSF). METHODS.A retrospective chart review was performed of 390 patients treated between 2002 and 2007 for choroidal melanoma at UCSF. Similar patients (n ¼ 1175) treated at the Liverpool Ocular Oncology Centre (LOOC) were included in the study. The data were analyzed using the model previously developed for LUMPO, an online prognostication tool combining multiple prognostic factors. Main outcome measures included all-cause mortality and melanoma-specific mortality. Reliability of the survival estimates in each group of patients was indicated by the C-indices of discrimination and Hosmer-Lemeshow test.RESULTS. Patients treated at UCSF tended to be younger with thicker tumors, and were more likely to receive proton beam radiotherapy as primary treatment compared to patients at LOOC. There were no significance differences with respect to ciliary body involvement, melanoma cytomorphology, and mitotic counts between the two groups. Death occurred in 140/390 (35%) patients from UCSF and 409/1175 (34%) patients from LOOC, with no difference in overall mortality by Kaplan-Meier analysis (log rank test, P ¼ 0.503). For allcause mortality and melanoma-specific mortality, the C-index of discrimination and HosmerLemeshow test at 5 years after treatment indicated good discrimination performance of the model, with no statistically significant difference between observed and predicted survival.CONCLUSIONS. Despite differences between the two cohorts, external validation in patients treated at UCSF indicates that LUMPO estimated the all-cause and melanoma-specific mortality well.

Genetic prognostication in uveal melanoma

“…; DeParis et al. ). This tool has been used effectively to detect patients with a predicted 5‐year mortality of at least 50% for inclusion in a prospective study evaluating metastasis screening by MRI in 188 high‐risk cases (Marshall et al.…”

“…Every prognostic tool should ideally be validated externally by different centres, which should ensure that tumour diameter and thickness are measured in a standardized manner and that structures such as ciliary body are defined consistently (DeParis et al. ).…”

Predictors of anxiety and depression 2 years following treatment in uveal melanoma survivors

“…About 40% to 50% of UM patients will develop metastatic disease within 10 years, for which treatment rarely prolongs life . Metastatic disease develops almost exclusively in patients whose tumor shows chromosome 3 deletion (ie, monosomy 3) . Patients are offered prognostic testing and informed of their prognosis if they accept it.…”

Prognostic biopsy of choroidal melanoma: an optimised surgical and laboratory approach

“…LUMPO was recently validated in a retrospective study using a cohort of 390 patients treated between 2002 and 2007 for choroidal melanoma at University College San Francisco 24. As for any study on prognostic biopsies in UM, one of the potential criticisms is that a single biopsy may be subject to sampling error for monosomy 3, as a result of intratumoral genetic heterogeneity 25…”