Validation of the Prognostic Usefulness of the Gene Expression Profiling Test in Patients with Uveal Melanoma

Tailoring surveillance imaging in uveal melanoma based on individual metastatic risk

OBJECTIVE

To develop surveillance programs for uveal melanoma patients, tailored to metastatic risk.

METHODS

Surveillance schedules were developed using the number needed to scan (NNS) concept, based on weighted average metastasis-free survival (MFS) rates from systematic review data of 18 prognostic groups (Disomy 3 (D3), Monosomy 3 (M3), EIF1AX-mutation, SF3B1-mutation, BAP1-mutation, high or low nBAP-1 immunohistochemistry, gene expression profiling classes (1;1A;1B;1PRAME-;1PRAME+;2;2PRAME-;2PRAME+), and V stages I-III).

RESULTS

In a typical surveillance schedule, involving biannual examinations years 1-5 and annual examinations years 6-10, the NNS varies dramatically from 1 to nearly infinity, underscoring the necessity for personalized surveillance approaches. On the basis of MFS data from 12 articles (n = 8046) and the targeted NNS level, the first surveillance examination under our model is recommended from 3 months to 5 years postdiagnosis. Specifically, the NNS 20 strategy requires an average of 10 examinations (SD 7), with D3 patients needing only two examinations (at 2- and 5-years' postdiagnosis), while those in GEP class 2PRAME+ require up to 17 examinations, scheduled between year 1 and 8. Under an NNS 20 protocol, we anticipate that 1-2% of examinations will lead to the use of effective treatments for metastatic disease, such as tebentafusp. The study presents customized surveillance schedules for all prognostic groups across various NNS levels, accompanied by a methodology for adapting surveillance to any desired NNS target.

CONCLUSION

Customizing uveal melanoma surveillance to match metastatic risks could transform current practices, ensuring more precise protocols, reducing unnecessary examinations, and directing health care resources to those in greatest need.

Ki67 is a better marker than PRAME in risk stratification of BAP1-positive and BAP1-loss uveal melanomas

BACKGROUND

Accurate risk stratification of uveal melanoma (UM) patients is important for determining the interval and frequency of surveillance. Loss of BAP1 expression has been shown to be strongly associated with UM-related death and metastasis.

METHODS

In this study of 164 enucleated UMs, we assessed the prognostic role of preferentially expressed antigen in melanoma (PRAME) expression and Ki67 proliferation index measured by digital quantitation using QuPath programme in patients with BAP1-positive and BAP1-loss UMs.

RESULTS

In univariate analyses with log-rank tests and Kaplan-Meier curves, PRAME further stratified only overall survival (OS) in BAP1-positive and BAP1-loss tumour groups. However, Ki67 further stratified both OS and disease-free survival (DFS) in BAP1-positive and BAP1-loss tumour groups. In multivariate analyses, Ki67 percentage and BAP1 were independent survival predictors for both OS and DFS, whereas PRAME was not a significant covariate. In model comparisons, combined Ki67 and BAP1 performed better than combined PRAME and BAP1 in risk-stratifying patients for both OS and DFS. Ki67 was better than PRAME in risk stratification of BAP1-positive UMs. Low Ki67 index correlated with significantly prolonged DFS in BAP1-loss UMs.

CONCLUSION

A panel of Ki67 and BAP1 could be a helpful risk stratification strategy for UM.

Gene Expression Profile Class Change in a Case of Aggressive, Recurrent Melanoma

Purpose: To report a novel case of a recurrent melanoma that had a change in its genetic expression profile (GEP) class over a 2-year period. Methods: This retrospective case study evaluated a patient with a recurrent uveal melanoma that changed classes from 1A to 1B. Results: A large melanoma was first treated with brachytherapy, and during that time genetic testing revealed a class 1A tumor. Two years later the tumor was noted to be enlarging, and the patient elected for enucleation. Subsequent GEP showed a class 1B tumor. Conclusions: An aggressive and large recurrent uveal melanoma that had changed from a class 1A to a class 1B tumor on subsequent GEP testing has never been reported before to our knowledge. It may imply that a recurrent or aggressive tumor has more mutations over time that could lead to a higher risk for metastasis. The natural course of a tumor's GEP class should be explored further.