Abstract
IntroductionUveal melanoma (UM) is the most common intraocular malignancy in adults. Plaque brachytherapy remains the dominant eyeball-conserving therapy for UM. Tumor regression in UM after plaque brachytherapy has been reported as a valuable prognostic factor. The present study aimed to develop an accurate machine-learning model to predict the 4-year risk of metastasis and death in UM based on ocular ultrasound data.Material and MethodsA total of 454 patients with UM were enrolled in this retrospective, single-center study. All patients were followed up for at least 4 years after plaque brachytherapy and underwent ophthalmologic evaluations before the therapy. B-scan ultrasonography was used to measure the basal diameters and thickness of tumors preoperatively and postoperatively. Random Forest (RF) algorithm was used to construct two prediction models: whether a patient will survive for more than 4 years and whether the tumor will develop metastasis within 4 years after treatment.ResultsOur predictive model achieved an area under the receiver operating characteristic curve (AUC) of 0.708 for predicting death using only a one-time follow-up record. Including the data from two additional follow-ups increased the AUC of the model to 0.883. We attained AUCs of 0.730 and 0.846 with data from one and three-time follow-up, respectively, for predicting metastasis. The model found that the amount of postoperative follow-up data significantly improved death and metastasis prediction accuracy. Furthermore, we divided tumor treatment response into four patterns. The D(decrease)/S(stable) patterns are associated with a significantly better prognosis than the I(increase)/O(other) patterns.ConclusionsThe present study developed an RF model to predict the risk of metastasis and death from UM within 4 years based on ultrasound follow-up records following plaque brachytherapy. We intend to further validate our model in prospective datasets, enabling us to implement timely and efficient treatments.
Highlights
Uveal melanoma (UM) is the most common intraocular malignancy in adults
The study population included adult patients that were clinically diagnosed with UM from July 2007 to Generally, iodine-125 plaque brachytherapy was used for tumors with a thickness of
A total of 454 patients with UM treated by plaque brachytherapy were included in the death analysis. 210 (46.3%) were male
Summary
Plaque brachytherapy remains the dominant eyeball-conserving therapy for UM. The present study aimed to develop an accurate machine-learning model to predict the 4-year risk of metastasis and death in UM based on ocular ultrasound data. Uveal melanoma (UM) is the most common aggressive ocular tumor in adults. The annual incidence rate per million people is 6 in non-Hispanic whites [1] and 0.3–0.6 in Asians [2,3,4]. New techniques such as proton beam therapy have been introduced [5], plaque brachytherapy, mainly using iodine-125, remains the dominant option as an eyeball-conserving treatment for UM. It is important to predict the metastasis risk and long-time survival accurately
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