To study the relationship between gene expression profile (GEP) subclass and American Joint Committee on Cancer (AJCC) stage in patients with uveal melanoma (UM).
A retrospective, multicenter study was undertaken with patients entered from nine major ocular oncology centers from across the United States. Three hundred sixty eligible patients had UM and underwent I-125 plaque brachytherapy with concurrent tumor biopsy with GEP testing between January 1, 2010, and October 28, 2014. Patient demographics and UM features were analyzed by both GEP and AJCC status.
Gene expression profile class divided the cohort into three groups: Class 1a (n = 186), Class 1b (n = 77), and Class 2 (n = 113). When classified using AJCC staging criteria, we found the following: Stage I in 91 cases (25.3%), Stage IIA in 143 cases (39.7%), Stage IIB in 89 cases (24.7%), Stage IIIA in 36 cases (10%), and Stage IIIB in 1 case (0.3%). There were no Stage IV cases, as lymph node and metastatic data were not collected as a part of this study. Among Stage I tumors, both high tumor height and high largest basal diameter were associated with a higher frequency of Class 2 status (P < 0.05). As UMs progress to a larger AJCC tumor group (T1–T4), the odds ratio of having a worse prognosis based on GEP class was 1.75 (95% CI, 1.36–2.25; P < 0.001). Similarly, as UMs progress to a higher AJCC stage, the odds ratio of having a worse prognosis based on GEP class was 1.69 (95% CI, 1.36–2.10; P < 0.001).
This report details the differences in clinical features between GEP subclasses and how they are distributed among the AJCC stages. When the tumors were grouped by AJCC staging criteria, both larger AJCC tumor (T) group and worsening AJCC stage were associated with worsening predicted prognosis, based on GEP subclass.
Gene expression profiling and American Joint Committee on Cancer staging are two of the most commonly used methods of prognostication in uveal melanoma. This retrospective study examined their relationship and found that worsening American Joint Committee on Cancer stage was predictive of worsening prognosis based on gene expression profile subclass.
*Department of Ophthalmology, Duke University, Durham, North Carolina;
†Blanton Eye Institute at Houston Methodist Hospital, Houston, Texas;
‡Retina Consultants of Houston, Houston, Texas;
§The Permanente Medical Group, San Francisco, California;
¶Department of Ophthalmology, The University of California, San Francisco, California
**Byers Eye Institute, Stanford University, Palo Alto, California; and
††Stanford Cancer Institute, Stanford University, Palo Alto, California.
Reprint requests: Amy C. Schefler, MD, 6560 Fannin Street, Suite 750, Houston, TX 77030; e-mail: firstname.lastname@example.org
P. Mruthyunjaya: provided by the Childress Family Foundation (NC), unrestricted departmental funding from Research to Prevent Blindness (New York, NY) and by grant P30 EY010572 from the National Institutes of Health (Bethesda, MD). A. Skalet: Supported by unrestricted departmental funding from Research to Prevent Blindness (New York, NY) and by grant P30 EY010572 from the National Institutes of Health (Bethesda, MD).
J. W. Harbour is the inventor of intellectual property used in the study and receives royalties from its commercialization. He is a paid consultant for Castle Biosciences, licensee of intellectual property presented in this article. P. Mruthyunjaya, M. Materin, and T. Aaberg Jr. are consultants for Castle Biosciences.
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Members of Ocular Oncology Study Consortium are listed in Appendix 1.