Purpose: to evaluate the effectiveness of enhanced surveillance protocols (EP) utilizing high frequency (HF) or enhanced modality (EM) compared to the standard protocol (SP) in detecting metastasis and determining their impact on overall survival (OS) in high-risk uveal melanoma (UM) patients. Methods: A total of 87 consecutive patients with Class 2 (high risk) primary UM were enrolled, with negative baseline systemic staging. The patients underwent systemic surveillance with either SP (hepatic ultrasonography [US] every 6 months) or EP (either HF [US every 3 months] or EM [incorporation hepatic computed tomography/magnetic resonance imaging]) following informed discussion. The main outcome measures were largest diameter of largest hepatic metastasis (LDLM), number of hepatic metastatic lesions, time to detection of metastasis (TDM), and OS. Results: This study revealed significant differences in LDLM between surveillance protocols, with the use of EP detecting smaller metastatic lesions (HF, EM, and SP were 1.5 cm, 1.6 cm, and 6.1 cm, respectively). Patients on the EM protocol had a lower 24-month cumulative incidence of >3 cm metastasis (3.5% EM vs. 39% SP;p= 0.021), while those on the HF protocol had a higher 24-month cumulative incidence of ≤3 cm metastasis compared to SP (31% HF vs. 10% SP;p= 0.017). Hazard of death following metastasis was significantly reduced in the EP (HR: 0.25; 95% CI: 0.07, 0.84), HF (HR: 0.23; 95% CI: 0.06, 0.84), and EM (HR: 0.11; 95% CI: 0.02, 0.5) groups compared to SP. However, TDM and OS did not significantly differ between protocols. Conclusions: Enhanced surveillance protocols improved early detection of hepatic metastasis in UM patients but did not translate into a survival advantage in our study cohort. However, early detection of metastasis in patients receiving liver-directed therapies may lead to improved overall survival.
目的：评估采用高频（HF）或增强影像模式（EM）的强化监测方案（EP）与标准方案（SP）相比，在高风险葡萄膜黑色素瘤（UM）患者中检测转移灶的有效性，并确定其对总生存期（OS）的影响。方法：共纳入87例连续收治的2类（高风险）原发性UM患者，基线全身分期均为阴性。在知情讨论后，患者接受SP（每6个月一次肝脏超声检查[US]）或EP（HF[每3个月一次US]或EM[纳入肝脏计算机断层扫描/磁共振成像]）进行全身监测。主要结局指标包括最大肝转移灶的最大直径（LDLM）、肝转移灶数量、转移灶检出时间（TDM）和OS。结果：本研究发现不同监测方案在LDLM方面存在显著差异，EP方案检测到的转移灶更小（HF、EM和SP方案分别为1.5 cm、1.6 cm和6.1 cm）。接受EM方案的患者24个月累积发生>3 cm转移灶的比例较低（EM 3.5% vs. SP 39%；p=0.021），而接受HF方案的患者24个月累积发生≤3 cm转移灶的比例高于SP方案（HF 31% vs. SP 10%；p=0.017）。与SP方案相比，EP（HR：0.25；95% CI：0.07，0.84）、HF（HR：0.23；95% CI：0.06，0.84）和EM（HR：0.11；95% CI：0.02，0.5）组患者发生转移后的死亡风险显著降低。然而，不同监测方案间的TDM和OS无显著差异。结论：强化监测方案提高了UM患者肝转移的早期检出率，但在本研究队列中并未转化为生存获益。不过，对于接受肝脏定向治疗的患者，早期发现转移灶可能有助于改善总生存期。
Surveillance for Metastasis in High-Risk Uveal Melanoma Patients: Standard versus Enhanced Protocols
肿瘤(癌症)患者之家