Hagström Anna, Witzenhausen Hans, Stålhammar Gustav
Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden; Ocular Oncology Service and St. Erik Ophthalmic Pathology Laboratory, St. Erik Eye Hospital, Stockholm, Sweden.
Can J Ophthalmol. 2025 Apr;60(2):e240-e252. doi: 10.1016/j.jcjo.2024.07.014. Epub 2024 Aug 13.
To develop surveillance programs for uveal melanoma patients, tailored to metastatic risk.
Surveillance schedules were developed using the number needed to scan (NNS) concept, based on weighted average metastasis-free survival (MFS) rates from systematic review data of 18 prognostic groups (Disomy 3 (D3), Monosomy 3 (M3), EIF1AX-mutation, SF3B1-mutation, BAP1-mutation, high or low nBAP-1 immunohistochemistry, gene expression profiling classes (1;1A;1B;1;1;2;2;2), and V stages I-III).
In a typical surveillance schedule, involving biannual examinations years 1-5 and annual examinations years 6-10, the NNS varies dramatically from 1 to nearly infinity, underscoring the necessity for personalized surveillance approaches. On the basis of MFS data from 12 articles (n = 8046) and the targeted NNS level, the first surveillance examination under our model is recommended from 3 months to 5 years postdiagnosis. Specifically, the NNS 20 strategy requires an average of 10 examinations (SD 7), with D3 patients needing only two examinations (at 2- and 5-years' postdiagnosis), while those in GEP class 2 require up to 17 examinations, scheduled between year 1 and 8. Under an NNS 20 protocol, we anticipate that 1-2% of examinations will lead to the use of effective treatments for metastatic disease, such as tebentafusp. The study presents customized surveillance schedules for all prognostic groups across various NNS levels, accompanied by a methodology for adapting surveillance to any desired NNS target.
Customizing uveal melanoma surveillance to match metastatic risks could transform current practices, ensuring more precise protocols, reducing unnecessary examinations, and directing health care resources to those in greatest need.
为葡萄膜黑色素瘤患者制定针对转移风险的监测方案。
基于18个预后组（三体3（D3）、单体3（M3）、EIF1AX突变、SF3B1突变、BAP1突变、nBAP-1免疫组化高或低、基因表达谱类别（1；1A；1B；1；1；2；2；2）以及V期I - III）的系统评价数据的加权平均无转移生存期（MFS）率，采用需扫描数（NNS）概念制定监测时间表。
在一个典型的监测方案中，包括第1 - 5年每半年检查一次，第6 - 10年每年检查一次，NNS从1到几乎无穷大显著变化，突出了个性化监测方法的必要性。根据12篇文章（n = 8046）的MFS数据和目标NNS水平，建议在我们的模型下首次监测检查在诊断后3个月至5年进行。具体而言，NNS 20策略平均需要10次检查（标准差7），D3患者仅需两次检查（诊断后2年和5年），而基因表达谱类别2的患者需要多达17次检查，安排在第1年至第8年之间。在NNS 20方案下，我们预计1 - 2%的检查将导致对转移性疾病使用有效治疗，如替贝福苏。该研究展示了针对不同NNS水平的所有预后组的定制监测时间表，以及一种将监测调整到任何所需NNS目标的方法。
根据转移风险定制葡萄膜黑色素瘤监测可改变当前做法，确保更精确的方案，减少不必要的检查，并将医疗资源导向最有需要的患者。
