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Abstract
Introduction. Predicting the course of uveal melanoma (UM) involves the analysis of clinical, morphological and genetic features of the tumor, which are numerous and heterogeneous in nature. The lack of a unified prognostic approach makes it difficult to stratify the risk of UM metastasis both in clinical practice and in informing patients about the prognosis of the disease, making the development of our own prognostic system a priority.
Aim. To develop a complex system for personalized prognosis of the risk of UM metastasis, taking into account clinical, morphological and molecular genetic factors.
Materials and Methods. 202 UM patients were selected for the study. Enucleation was performed as primary treatment in 57 % of cases (n = 115) and radiotherapy in 43 % of cases (n = 83). In eye-sparing treatment, tumor material for cytological and molecular genetic studies was obtained by fine-needle aspiration biopsy (FNAB). Key clinical (tumor size and localization, sex and age), morphological (cell type and ciliary body involvement) and molecular genetic (mutations in EIF1AX, SF3B1, PPARG, MYC genes) factors were assessed.
Results. The mean follow-up was 42 months (median 35, min 1, max 182). There were 78 cases of metastatic melanoma (39 %) during this period. The following factors were identified as statistically significant (p < 0.01) predictors of UM metastasis: tumor size, localization and cell type, mutations in the EIF1AX, PPARG and MYC genes.
Conclusion. The developed multifactor prognostic system for predicting the risk of UM metastasis taking into account key prognostic factors allowed us to stratify the risk of metastasis by scores and to identify three significantly different (p < 0.01) prognosis categories: ‘unfavorable’, ‘average’ and ‘favorable’. The system needs to be validated on data from other UM patients.
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