Prediction of metastasis

Abstract

AbstractPurpose To describe the Liverpool approach to the prediction of metastasis from uveal melanoma.Methods The Liverpool Ocular Oncology Research Group (LOORG) has developed the Liverpool Uveal Melanoma Prognosticator Online (LUMPO), which is available free on the internet at www.ocularmelanomaonline.com. This estimates the survival probability according to age, sex, largest basal tumour diameter, tumour thickness, ciliary body involvement, extraocular spread, melanoma cytomorphology, mitotic count, extravascular matrix pattern and chromosome 3 status. An all‐cause survival curve is generated using the accelerated failure time mathematical model. A survival curve for the general British population of the same age and sex is also generated. By subtracting one curve from the other it is possible to estimate metastatic mortality.Results LUMPO has been developed with data on more than 3000 patients and has been thoroughly validated. The results depend greatly on the accuracy of clinical measurements, mitotic counts and genetic typing. We have found FISH to be inadequate and have replaced this with MLPA and MSA, reserving the latter for small biopsy samples. Biopsy techniques have also improved and these have enhanced the results of prognostication.Conclusion With advances in biopsy, genetic testing and multivariate analysis, we are now able to provide personalised prognostication. This enhances the quality of life of patients with a good prognosis while enabling us to target intensive care,such as counselling and screening, at high‐risk patients. Improved prognostication has also enhances opportunities for basic science research, facilitating the identification of molecular abnormalities influencing the metastatic process.