Uveal melanoma: In the era of new treatments

A Noninvasive Nanoeyedrop Therapy for the Inhibition of Uveal Melanoma: Tetrahedral Framework Nucleic Acid-Based Bioswitchable MicroRNA Delivery System

Uveal melanoma (UM) is the most prevalent primary intraocular malignancy, exhibiting pronounced invasive characteristics and a dismal prognosis. Conventional therapeutic modalities, including radiotherapy, laser therapy, and surgery, are frequently invasive and can lead to complications, underscoring the need for the development of efficacious, safe, and noninvasive therapeutic approaches. This study investigated a tetrahedral framework nucleic acid (tFNA)-based bioswitchable microRNA (miRNA) delivery system, designated BiRDS, engineered for the inhibition of UM through the use of miRNA suppressors via noninvasive eyedrops. The BiRDS construct exhibited a tetrahedral structure, which was small in size, easily synthesizable, stable, and biosafe, and was able to efficiently carry miR-30a-5p into UM cells. Functionally, BiRDS was observed to inhibit the proliferation, migration, and invasion of UM cells while promoting apoptosis through the miR-30a-5p/E2F7 axis. It is noteworthy that BiRDS nanoeyedrops were able to penetrate the complex ocular barrier structure and reach the fundus, thereby inhibiting the growth of UM in a xenograft model. As a patient-friendly, eyedrop-based miRNA delivery system, BiRDS not only inhibited UM without enucleation of the eyeball but was also expected to improve patient compliance and quality of life while providing a safer alternative for ocular drug administration. This work substantiates BiRDS nanoeyedrops as a potential paradigm shift in the local treatment of early UM, facilitating its application in treating other ocular diseases via miRNA therapies.

Extracellular vesicles in uveal melanoma - Biological roles and diagnostic value

Uveal melanoma (UM), which originates from the uveal tract of the eye, is the most common and aggressive intraocular cancer in adults. The detection of genetic markers is crucial for an accurate diagnosis, but this requires tumor biopsies that can be challenging to obtain. Extracellular vesicles (EVs) have emerged as potential biomarkers for UM due to their presence in biological fluids and their ability to carry disease-related biomolecules such as proteins and nucleic acids. Increasing evidence indicates that EVs released from UM cells play crucial roles in UM development, including cancer progression, pre-metastatic niche formation, and metastasis. Moreover, many studies have demonstrated that UM-derived EVs carry proteins and microRNAs that might be used as biomarkers. This review explores the role of EVs in UM, focusing on their biological functions and their potential as diagnostic and prognostic biomarkers of UM. Additionally, current challenges to the use of UM-derived EVs in clinical translation were identified, as well as perspectives and future directions in the field.

Long-Term Outcomes of Ocular and Visual Preservation After Carbon Ion Radiation Therapy for Choroidal Malignant Melanoma

PURPOSE

This study aimed to evaluate the long-term results of carbon ion radiation therapy (CIRT) for choroidal malignant melanoma (CMM), especially regarding the preservation of the eye and visual acuity (VA).

METHODS AND MATERIALS

A total of 250 patients with intraocularly localized CMM treated with CIRT between January 2003 and September 2021 were included. The dose prescription included 60 to 85 Gy/4 to 5 fr, with only 68 Gy/4 fr used from 2018 onward. The rotating gantry system with scanning beams was introduced in April 2018. Adverse events (AEs) were graded according to the Common Terminology Criteria for AEs (version 5.0.). For secondary glaucoma, tumor-related visual field defects were excluded from the evaluation. For VA, 245 patients with VA ≥ light perception (LP) were followed up. Effective VA (≥20/200, Snellen equivalent), counting fingers, and LP were used as indicators.

RESULTS

The median age was 55 (15-86) years. The T categories 1, 2, 3, and 4 were observed in 16 (6.4%), 41 (16.4%), 189 (75.6%), and 4 (1.6%) patients, respectively. With a median follow-up of 72.5 months, the 5- and 8-year overall survival rates were 87.5% and 84.2%, respectively; the 5- and 8-year local control rates were 94.4% and 92.9%, respectively. At the last follow-up, 19 of 250 patients (7.6%) underwent enucleation, 15 caused by local recurrence and 4 caused by AEs. Secondary glaucoma grades 1, 2, and 3 to 4 were observed in 22 (8.8%), 49 (19.6%), and 5 (2.0%) of patients, respectively. At the last follow-up, ≥ effective VA, ≥ counting fingers, and ≥ LP were maintained in 80 (33%), 120 (49%), and 154 (63%) of patients, respectively. Preservation rate of ≥ LP vision at 5 and 8 years after CIRT was 65.7% and 55.3%, respectively.

CONCLUSIONS

CIRT for CMM is a promising treatment for both tumor control and preservation of the eye and VA.

Unveiling the role of ACTL6A in uveal melanoma metastasis and immune microenvironment

PURPOSE

To predict and evaluate the possible mechanisms and clinical value of ACTL6A in the prognosis and development of UM.

METHODS

Bioinformatics analyze the relationship between ACTL6A and immunity in UM, which derived from TCGA, Gene Expression Omnibus (GEO) databases. Tumor-infltrated immune cells were demonstrated using QUANTISEQ and MCP-counter. Furthermore, scRNA-seq was used to detect ACTL6A expression, distribution, immune infiltration and revealing the gene expression profile of UM.

RESULTS

The expression of ACTL6A was lower in UM compared with pantumor in TCGA databases. Kaplan-Meier analysis revealed that downregulated ACTL6A was associated with poor OS, and ACTL6A was associated with cancer stem cells (CSCs) and immune infiltration. Moreover, ACTL6A might act as a chemotherapy resistance gene and closely relate- to epithelial-mesenchymal transition. Analysis in 8 GSE databases showed that IL13, TPTE, IL17B and CCL22 genes were significantly overexpressed in metastatic UM. Furthermore, the single-cell transcriptomic profling identified a new cell cluster - as a unique type of immune cell, which associating with malignant cell heterogeneity and complexity, and further revealing that the metastasis of UM is mainly associated with CD4 Tconv, B , CD8 Tex, and Plasma cells.

CONCLUSIONS

Downregulated ACTL6A acts as a risk factor for poor prognosis in UM, which implies as an potential prognostic marker for independent targeted immunotherapy.

Efficacy and safety of robotic Cyberknife radiotherapy in uveal melanoma: a systematic review and meta-analysis

OBJECTIVES

This systematic review is aimed to evaluate the efficacy and safety of robotic Cyberknife radiotherapy (CKRT) in the treatment of uveal melanoma (UM).

METHODS

Clinical studies published in English that assessed the efficacy and safety of robotic CKRT in UM were systematically searched in PubMed, Web of Science, Cochrane and Embase from inception to July 2023. Studies reporting extraocular tumours or other radiosurgery approaches were excluded. Outcomes measured were tumour size, reflectivity, local tumour control rate, eye retention rate, survival rate, complication rate, recurrence rate, and metastasis rate.

RESULTS

Ten eligible articles involving 2370 patients with 2372 UMs were included in evidence synthesis. Meta-analysis showed 811 of 912 patients (0.89, 95% Cl: 0.86, 0.92) maintained local control for three years, and 1448 of 1724 patients (0.84, 95% Cl: 0.81, 0.88) preserved the eye in three years. During follow-up, 91% (0.91, 95% Cl: 0.85, 0.97) patients survived and 351 of 1720 patients (0.23, 95% Cl: 0.09, 0.37) involving 1722 eyes had tumour recurrence. In addition, 1376 patients (0.79, 95% Cl: 0.77, 0.82) preserved the eyeball in five years. Following treatment, approximately 20% of patients had radiation retinopathy (95% Cl: 0.13, 0.28), 19% developed glaucoma (95% Cl: 0.11, 0.28), and 22% experienced retinal detachment (95% Cl: 0.07, 0.36).

CONCLUSIONS

CKRT is a viable, noninvasive RT for UM. The rate of local tumour control following treatment is comparable to that of other RT approaches, providing additional options based on the patient's condition.

Identification of new candidate genes for the hereditary predisposition to uveal melanoma: IGCMU trial

Introduction

Uveal melanoma (UM) is a rare ocular cancer. While germline mutations in genes such as BAP1 and MBD4 account for approximately 20% of familial UM cases, the hereditary factors underlying the remaining cases remain unknown. Epidemiological studies have suggested an increased risk of prostate cancer, thyroid cancer, and leukemia among patients with UM, indicating potential unidentified genetic predispositions. This study aims to identify new candidate genes associated with a hereditary predisposition to UM.

Methods

This single-center study, conducted at Centre Jean Perrin, will involve the exome sequencing of 50 patients with UM who do not harbor known pathogenic variants in the BAP1 or MBD4 genes. The primary objective is to identify novel candidate genes associated with hereditary cancer predisposition among UM patients. A several-step-bioinformatic analysis will be conducted to identify the genes of interest. A secondary objective is to explore genes known to be involved in predisposition to other cancers, already described in the occurrence of uveal melanoma, but where an association has not been fully established yet. The study has begun in October 2024, with patient recruitment lasting 12 months. No follow-up period is planned, but the duration of the genetic analyses is estimated at six months, with the final study report expected by October 2026.

Discussion

The identification of novel hereditary predisposition genes for UM could significantly enhance genetic counselling and surveillance strategies for families affected. This study could also contribute to a better understanding of the genetic landscape of UM, potentially leading to more personalized and effective options for its detection.

Trial registration

ClinicalTrials.gov, identifier NCT06550674, registered in August 2024. Protocol: version 1.0, January 18th, 2024.

Single-cell RNA sequencing and AlphaFold 3 insights into cytokine signaling and its role in uveal melanoma

Background

Uveal melanoma (UVM) is a form of eye cancer with a poor prognosis, particularly in metastatic patients. This study aimed to elucidate the cellular heterogeneity within UVM and identify prognostic biomarkers.

Methods

We performed single-cell RNA sequencing (scRNA-seq) on primary and metastatic UVM samples. A UVM-specific gene signature was constructed using LASSO regression and validated via ROC curve analysis in the TCGA-UVM and GSE84976 cohorts. AlphaFold 3 was used to predict the 3D structures of key proteins. T-cell populations were analyzed using pseudotime trajectory mapping and interaction network visualization. CRISPR-Cas9 screening analysis was conducted to identify hub genes and cytokine pathways that may serve as therapeutic targets. Additionally, we constructed the Dictionary of Immune Responses to Cytokines at single-cell resolution to evaluate cytokine signatures.

Results

ScRNA-seq revealed five major cell types within UVMs and subdivided them into seven distinct subtypes. Cytokine signaling analysis revealed differential expression of cytokine signaling in immune-related genes (CSIRGs) across these subtypes in primary and metastatic tumors. The UVM-specific gene signature demonstrated high predictive accuracy in ROC curve analysis and was associated with overall survival in Kaplan-Meier survival analyses. Additionally, AlphaFold 3 predicted the 3D structures of key proteins with high confidence. T-cell population analysis revealed complex developmental pathways and interaction networks in UVM. Myeloid-derived suppressor cells (MDSCs) were found to be increased in metastatic UVM, correlating with the enrichment of GM-CSF. CRISPR-Cas9 screening analysis identified hub genes and cytokine pathways with low gene effect scores across cell lines, indicating their potential importance in UVM.

Conclusion

This study identified critical cellular subtypes and prognostic biomarkers in UVM, shedding light on targeted therapies. The insights into cytokine signaling and T-cell dynamics within the UVM microenvironment provide a foundation for developing personalized therapeutic strategies to improve patient outcomes.

Direct Prediction of 48 Month Survival Status in Patients with Uveal Melanoma Using Deep Learning and Digital Cytopathology Images

BACKGROUND

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. The median overall survival time for patients who develop metastasis is approximately one year. In this study, we aim to leverage deep learning (DL) techniques to analyze digital cytopathology images and directly predict the 48 month survival status on a patient level.

METHODS

Fine-needle aspiration biopsy (FNAB) of the tumor was performed in each patient diagnosed with UM. The cell aspirate was smeared on a glass slide and stained with H&E. Each slide then underwent whole-slide scanning. Within each whole-slide image, regions of interest (ROIs) with UM cells were automatically extracted. Each ROI was converted into super pixels, and the super pixels were automatically detected, segmented and annotated as "tumor cell" or "background" using DL. Cell-level features were extracted from the segmented tumor cells. The cell-level features were aggregated into slide-level features which were learned by a fully connected layer in an artificial neural network, and the patient survival status was predicted directly from the slide-level features. The data were partitioned at the patient level (78% training and 22% testing). Our DL model was trained to perform the binary prediction of yes-versus-no survival by Month 48. The ground truth for patient survival was established via a retrospective chart review.

RESULTS

A total of 74 patients were included in this study (43% female; mean age at the time of diagnosis: 61.8 ± 11.6 years), and 207,260 unique ROIs were generated for model training and testing. By Month 48 after diagnosis, 18 patients (24%) died from UM metastasis. Our hold-out test set contained 16 patients, where 6 patients had passed away and 10 patients were alive at Month 48. When using a sensitivity threshold of 80% in predicting UM-specific death by Month 48, our model achieved an overall accuracy of 75%. Within the subgroup of patients who died by Month 48, our model achieved a prediction accuracy of 83%. Of note, one patient in our test set was a clinical surprise, namely death by Month 48 despite having a GEP class 1A tumor, which typically portends a good prognosis. Our model correctly predicted this clinical surprise as well.

CONCLUSIONS

Our DL model was able to predict the Month 48 survival status directly from digital cytopathology images obtained from FNABs of UM tumors with reasonably robust performance. This approach, if validated prospectively, could serve as an alternative survival prediction tool for patients with UM to whom GEP is not available.

Oncolytic Viruses and Immunotherapy for the Treatment of Uveal Melanoma and Retinoblastoma: The Current Landscape and Novel Advances

Intraocular malignant tumors are rare; however, they can cause serious life-threatening complications. Uveal melanoma (UM) and retinoblastoma (RB) are the most common intraocular tumors in adults and children, respectively, and come with a great disease burden. For many years, several different treatment modalities for UM and RB have been proposed, with chemotherapy for RB cases and plaque radiation therapy for localized UM as first-line treatment options. Extraocular extension, recurrence, and metastasis constitute the major challenges of conventional treatments. To overcome these obstacles, immunotherapy, which encompasses different treatment options such as oncolytic viruses, antibody-mediated immune modulations, and targeted immunotherapy, has shown great potential as a novel therapeutic tool for cancer therapy. These anti-cancer treatment options provide numerous advantages such as selective cancer cell death and the promotion of an anti-tumor immune response, and they prove useful in preventing vision impairment due to macular and/or optic disc involvement. Numerous factors such as the vector choice, route of administration, dosing, and patient characteristics must be considered when engineering an oncolytic virus or other forms of immunotherapy vectors. This manuscript provides an in-depth review of the molecular design of oncolytic viruses (e.g., virus capsid proteins and encapsulation technologies, vectors for delivery, cell targeting) and immunotherapy. The most recent advances in preclinical- and clinical-phase studies are further summarized. The recent developments in virus-like drug conjugates (i.e., AU011), oncolytic viruses for metastatic UM, and targeted immunotherapies have shown great results in clinical trials for the future clinical application of these novel technologies in the treatment algorithm of certain intraocular tumors.

Efficacy and safety of tebentafusp in patients with metastatic uveal melanoma: A systematic review and meta-analysis

Patients with metastatic uveal melanoma (mUM) have a poor prognosis, and few appropriate medications are available. Tebentafusp is approved by the Food and Drug Administration for mUM recently. However, the real efficacy and safety of tebentafusp are still unclear. We searched PubMed, Embase, and Cochrane Library from inception to March 20, 2024. The research was reported based on the preferred reporting items for systematic reviews and meta-analysis guidelines. We used random effects models to aggregate data on the response rates and adverse events of tebentafusp therapy. Six studies met the inclusion criteria with a total sample of 589 participants. The pooled objective response rate was 0.08 (95% CI: 0.05-0.12), and pooled disease control rate was 0.51 (95% CI: 0.44-0.57). The overall incidence was 0.99 (95% CI: 0.95-1.00) for any grade adverse events, 0.50 (95% CI: 0.41-0.59) for grade 3-4 adverse events, and 0.01 (95% CI: 0-0.03) for discontinuation due to adverse events. Tebentafusp exhibits promising treatment outcomes for mUM patients. Although accompanied with a common occurrence of adverse events, which can typically be managed and controlled. Future research is necessary for substantiating these findings and refining guidelines for management of mUM.

The BET inhibitor JQ1 suppresses tumor survival by ABCB5-mediated autophagy in uveal melanoma

Uveal melanoma (UM), the most common adult ocular tumor, is aggressive and resistant to treatment, posing threat to patients' lives. The novel, effective therapies and the exploration of chemosensitizer for UM are imperative. The anticancer efficacy was evaluated with and without JQ1 treatment or ABCB5 gene silencing or overexpression. RNA sequencing identified downstream effectors in JQ1-treated cells. Integrated analysis of The Cancer Genome Atlas data (TCGA) and immunohistochemistry (IHC) revealed the oncogenic role of ABCB5. Functional analyses of JQ1 and defective ABCB5 were conducted using flow cytometry, transmission electron microscopy (TEM), IHC and western blot. The effects of JQ1 were validated in a heterotopic tumor model derived from OCM-1 cells. JQ1 inhibited cell proliferation, migration and invasion, induced cell cycle arrest and promoted apoptosis. JQ1 also suppressed the survival of UM in heterotopic tumor model. RNA sequencing indicated that JQ1 down-regulated the expressions of ABCB5 and autophagy-related genes, which was confirmed in vitro and in vivo by western blot. ABCB5, a marker associated with cancer stem cells and chemo-resistance, exhibited heightened expression in UM tissues, linked to immune infiltration. Notably, disrupting ABCB5 expression impeded UM cell proliferation and interfered with autophagy. Moreover, the overexpression of ABCB5 promoted cell proliferation, migration and invasion, and rescued autophagy related gene expression. Of note, JQ1 enhanced the sensitivity of OCM-1 cells to chemotherapy. Thus JQ1 inhibits UM survival via ABCB5-mediated autophagy and enhances chemo-sensitivity, suggesting potential for BET-based approaches in UM clinical management.

Proton Therapy in Uveal Melanoma

Background/Objectives: Uveal melanoma is the most common primary intraocular malignancy in adults. Treatment options for localized, early-stage disease include enucleation, brachytherapy, and proton beam therapy. This review aims to evaluate the role of proton therapy in the definitive management of uveal melanoma, focusing on its physics, radiobiology, treatment techniques, and associated outcomes. Methods: This narrative review synthesizes current literature on proton therapy for uveal melanoma, emphasizing case selection, treatment efficacy, and side effects. Results: Proton therapy offers significant advantages for thicker uveal melanomas (over 8 mm) due to its unique physical properties, including a rapid dose fall-off that protects critical structures like the retina and optic nerve. Proton therapy may have benefits in tumor control for ocular melanomas given its increased relative biological effectiveness relative to photon therapy for these typically more radioresistant melanomas. Proton therapy may also hold special value for uveal melanomas in close proximity to the optic nerve, as patients are at high risk of visual toxicities with brachytherapy. The review discusses the efficacy of proton therapy across small, medium, and large tumors, along with strategies for improving patient survival through combined systemic therapy. Additionally, the potential of ocular reirradiation with proton therapy is addressed. Conclusions: Proton therapy is an effective treatment for uveal melanoma. It offers advantages over brachytherapy for large tumors, tumors that are close to the optic nerve or insertion of extra-ocular muscles.

STAT6/LINC01637 axis regulates tumor growth via autophagy and pharmacological targeting STAT6 as a novel strategy for uveal melanoma

Compelling evidence has revealed a novel function of the STAT pathway in the pathophysiology of uveal melanoma (UM); however, its regulatory mechanisms remain unclear. Here, we analyzed the clinical prognostic value of STAT family genes in UM patients using bioinformatics approaches and found that high STAT6 expression is associated with poor prognosis. Furthermore, cellular experiments and a nude mouse model demonstrated that STAT6 promotes UM progression through the autophagy pathway both in vivo and in vitro. Next, RIP-PCR revealed that STAT6 protein binds to LINC01637 mRNA, which in turn regulates STAT6 expression to promote UM growth. Finally, molecular docking indicated that STAT6 is a target of Zoledronic Acid, which can delay UM tumorigenicity by inhibiting STAT6 expression. Taken together, our results indicate that the STAT6/LINC01637 axis promotes UM progression via autophagy and may serve as a potential therapeutic target for UM.

AIBI Modified Mesoporous Copper Sulfide Nanocomposites for Efficient Non-Oxygen Dependent Free Radicals-Assisted Photothermal Therapy in Uveal Melanoma

Uveal melanoma (UM) is an ocular cancer predominantly affecting adults, characterized by challenging diagnostic outcomes. This research endeavors to develop an innovative multifunctional nanocomposite system sensitive to near-infrared (NIR) radiation, serving as both a non-oxygen free-radical generator and a photothermal agent. The designed system combines azobis isobutyl imidazoline hydrochloride (AIBI) with mesoporous copper sulfide (MCuS) nanoparticles. MCuS harnesses NIR laser energy to induce photothermal therapy, converting light energy into heat to destroy cancer cells. Simultaneously, AIBI is activated by the NIR laser to produce alkyl radicals, which induce DNA damage in remaining cancer cells. This distinctive feature equips the designed system to selectively eliminate cancers in the hypoxic tumor microenvironment. MCuS is also beneficial to scavenge the overexpressed glutathione (GSH) in the tumor microenvironment. GSH generally consumes free radicals and hiders the PDT effect. To enhance control over AIBI release in cancer cells, 1-tetradecyl alcohol (TD), a phase-changing material, is introduced onto the surface of MCuS nanoparticles to create the final AMPT nanoparticle system. In vitro and in vivo experiments confirm the remarkable anti-tumor efficacy of AMPT. Notably, the study introduces an orthotopic tumor model for UM, demonstrating the feasibility of precise and effective targeted treatment within the ocular system.

Emerging therapeutic strategies for metastatic uveal melanoma: Targeting driver mutations

Uveal melanoma (UM) is the most common primary malignant intraocular tumor in adults. Although primary UM can be effectively controlled, a significant proportion of cases (40% or more) eventually develop distant metastases, commonly in the liver. Metastatic UM remains a lethal disease with limited treatment options. The initiation of UM is typically attributed to activating mutations in GNAQ or GNA11. The elucidation of the downstream pathways such as PKC/MAPK, PI3K/AKT/mTOR, and Hippo-YAP have provided potential therapeutic targets. Concurrent mutations in BRCA1 associated protein 1 (BAP1) or splicing factor 3b subunit 1 (SF3B1) are considered crucial for the acquisition of malignant potential. Furthermore, in preclinical studies, actionable targets associated with BAP1 loss or oncogenic mutant SF3B1 have been identified, offering promising avenues for UM treatment. This review aims to summarize the emerging targeted and epigenetic therapeutic strategies for metastatic UM carrying specific driver mutations and the potential of combining these approaches with immunotherapy, with particular focus on those in upcoming or ongoing clinical trials.

Cancer stem-like cells in uveal melanoma: novel insights and therapeutic implications

Uveal melanoma (UM) is the most common primary ocular tumor in the adult population. Even though these primary tumors are successfully treated in 90% of cases, almost 50% of patients ultimately develop metastasis, mainly in the liver, via hematological dissemination, with a median survival spanning from 6 to 12 months after diagnosis. In this context, chemotherapy regimens and molecular targeted therapies have demonstrated poor response rates and failed to improve survival. Among the multiple reasons for therapy failure, the presence of cancer stem-like cells (CSCs) represents the main cause of resistance to anticancer therapies. In the last few years, the existence of CSCs in UM has been demonstrated both in preclinical and clinical studies, and new molecular pathways and mechanisms have been described for this subpopulation of UM cells. Here, we will discuss the state of the art of CSC biology and their potential exploitation as therapeutic target in UM.

Identification and validation of a costimulatory molecule-related signature to predict the prognosis for uveal melanoma patients

Uveal melanoma (UVM) is the most common primary tumor in adult human eyes. Costimulatory molecules (CMs) are important in maintaining T cell biological functions and regulating immune responses. To investigate the role of CMs in UVM and exploit prognostic signature by bioinformatics analysis. This study aimed to identify and validate a CMs associated signature and investigate its role in the progression and prognosis of UVM. The expression profile data of training cohort and validation cohort were downloaded from The Cancer Genome Atlas (TCGA) dataset and the Gene Expression Omnibus (GEO) dataset. 60 CM genes were identified, and 34 genes were associated with prognosis by univariate Cox regression. A prognostic signature was established with six CM genes. Further, high- and low-risk groups were divided by the median, and Kaplan-Meier (K-M) curves indicated that high-risk patients presented a poorer prognosis. We analyzed the correlation of gender, age, stage, and risk score on prognosis by univariate and multivariate regression analysis. We found that risk score was the only risk factor for prognosis. Through the integration of the tumor immune microenvironment (TIME), it was found that the high-risk group presented more immune cell infiltration and expression of immune checkpoints and obtained higher immune scores. Enrichment analysis of the biological functions of the two groups revealed that the differential parts were mainly related to cell-cell adhesion, regulation of T-cell activation, and cytokine-cytokine receptor interaction. No differences in tumor mutation burden (TMB) were found between the two groups. GNA11 and BAP1 have higher mutation frequencies in high-risk patients. Finally, based on the Genomics of Drug Sensitivity in Cancer 2 (GDSC2) dataset, drug sensitivity analysis found that high-risk patients may be potential beneficiaries of the treatment of crizotinib or temozolomide. Taken together, our CM-related prognostic signature is a reliable biomarker that may provide ideas for future treatments for the disease.