Wiens Lisa, Grözinger Gerd, Dittmann Helmut, Thiel Karolin, Leiter Ulrike, Amaral Teresa, Nanz Lena, Flatz Lukas, Forschner Andrea
Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Liebermeisterstr. 25, Tübingen 72076, Germany.
Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany.
Ther Adv Med Oncol. 2024 Aug 23;16:17588359241273020. doi: 10.1177/17588359241273020. eCollection 2024.
Uveal melanoma is the most common malignant tumor of the eye in adults. About half of the patients develop distant metastases, most commonly liver metastases (>90%). These are associated with poorer overall survival compared to patients with extrahepatic metastases.
In this retrospective study, patients diagnosed with metastatic uveal melanoma between January 2005 and December 2021 and treated at the Center for Dermato-oncology at the University of Tübingen, were included. The total cohort was divided into two groups. Group 1, in which the first diagnosis of metastasis was between 2005 and 2015 and group 2 with first metastasis between 2016 and 2021. Melanoma-specific survival (MSS) and progression-free survival (PFS) were calculated with the Kaplan-Meier method, test for differences was performed by the log-rank test.
A total of 167 patients were included in the study. Since more than 90% of patients had developed liver metastases as their first site of metastasis, we focused our analysis on patients with liver metastases. Median MSS was 28 months (95% confidence interval (CI) (22.8-33.2 months)) in patients receiving first-line liver-directed therapy ( = 89) compared to 10 months (95% CI (8.4-11.6 months)) for patients with first-line systemic therapy ( = 45). The best MSS was found in patients of group 2 and liver-directed therapy as first-line treatment. Since survival with first-line liver-directed therapy was significantly better in group 2, subsequent systemic therapies must also be considered, especially immune checkpoint inhibitors.
This analysis revealed that MSS has improved significantly in recent years. In our analysis, first-line liver-directed therapy was associated with improved survival compared to first-line systemic therapy. Further studies are urgently needed, for example, to investigate the combination of immune checkpoint inhibition or tebentafusp with liver-specific procedures from the outset.
葡萄膜黑色素瘤是成人中最常见的眼部恶性肿瘤。约一半的患者会发生远处转移，最常见的是肝转移（>90%）。与肝外转移患者相比，这些患者的总生存期较差。
在这项回顾性研究中，纳入了2005年1月至2021年12月期间在图宾根大学皮肤肿瘤学中心诊断为转移性葡萄膜黑色素瘤并接受治疗的患者。整个队列分为两组。第1组，首次转移诊断时间在2005年至2015年之间；第2组，首次转移时间在2016年至2021年之间。采用Kaplan-Meier方法计算黑色素瘤特异性生存期（MSS）和无进展生存期（PFS），通过对数秩检验进行差异检验。
该研究共纳入167例患者。由于超过90%的患者以肝转移作为首个转移部位，我们将分析重点放在肝转移患者上。接受一线肝脏定向治疗的患者（n = 89）的中位MSS为28个月（95%置信区间（CI）（22.8 - 33.2个月）），而接受一线全身治疗的患者（n = 45）为10个月（95% CI（8.4 - 11.6个月））。第2组患者且以肝脏定向治疗作为一线治疗时MSS最佳。由于第2组中一线肝脏定向治疗的生存期明显更好，因此也必须考虑后续的全身治疗，尤其是免疫检查点抑制剂。
该分析表明近年来MSS有显著改善。在我们的分析中，与一线全身治疗相比，一线肝脏定向治疗与生存期改善相关。迫切需要进一步的研究，例如从一开始就研究免疫检查点抑制或替贝福苏与肝脏特异性治疗方法的联合应用。
