Gene Expression Profiling in Uveal Melanoma: Five-Year Prospective Outcomes and Meta-Analysis
Thomas M. Aaberg, Kyle R. Covington, Tony Tsai, Yevgeniy Shildkrot, Kristen M. Plasseraud, Katherina M. Alsina, Kristen M. Oelschlager, Federico A. Monzon
Abstract
<b><i>Introduction:</i></b> The prognostic 15-gene expression profile (15-GEP) test for uveal melanoma (UM) predicts metastatic risk based on primary tumor biology. Here we report outcomes from a prospective registry of 15-GEP-tested patients, and a meta-analysis with published cohorts. <b><i>Objectives:</i></b> Management and 5-year clinical outcomes following 15-GEP testing were evaluated. <b><i>Methods:</i></b> Eighty-nine patients with 15-GEP results were prospectively enrolled at four centers. Physician-recommended management plans were collected, and clinical outcomes tracked every 6 months. <b><i>Results:</i></b> Eighty percent of Class 1 (low-risk) patients underwent low-intensity management; all Class 2 (high-risk) patients underwent high-intensity management (<i>p</i> &#x3c; 0.0001). Median follow-up for event-free patients was 4.9 years. Five Class 1 (10%) and 23 Class 2 (58%) tumors metastasized (<i>p</i> &#x3c; 0.0001). Five-year Class 1 and 2 metastasis-free survival rates were 90% (81–100%) and 41% (27–62%; <i>p</i> &#x3c; 0.0001), and melanoma-specific survival rates were 94% (87–100%) and 63% (49–82%; <i>p</i> = 0.0007). Class 2 was the only independent predictor of metastasis and was associated with increased risk for metastasis and mortality by meta-analysis. <b><i>Conclusions:</i></b> UM patient management is guided by 15-GEP testing. Class 2 patients were managed more intensely, in accordance with an observed metastatic rate of &#x3e;50%; Class 1 patients were safely spared intensive surveillance, resulting in appropriate utilization of healthcare resources.