Patients presenting with metastases: stage IV uveal melanoma, an international study

ObjectiveTo analyse ocular and systemic findings of patients presenting with systemic metastasis.Methods and analysisIt is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases.ResultsOf 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1–T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category.ConclusionsThough higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.

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Non-operative management of the primary tumour in patients with incurable stage IV colorectal cancer

British Journal of Surgery ◽

10.1046/j.0007-1323.2001.01915.x ◽

2001 ◽

Vol 88 (10) ◽

pp. 1352-1356 ◽

Cited By ~ 114

Author(s):

A. I. Sarela ◽

J. A. Guthrie ◽

M. T. Seymour ◽

E. Ride ◽

P. J. Guillou ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Tumour ◽

Stage Iv ◽

Operative Management ◽

Stage Iv Colorectal Cancer ◽

Non Operative Management

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Feasibility of whole-body diffusion-weighted MRI for detection of primary tumour, nodal and distant metastases in women with cancer during pregnancy: a pilot study

European Radiology ◽

10.1007/s00330-017-5126-z ◽

2017 ◽

Vol 28 (5) ◽

pp. 1862-1874 ◽

Cited By ~ 13

Author(s):

Sileny N. Han ◽

Frédéric Amant ◽

Katrijn Michielsen ◽

Frederik De Keyzer ◽

Steffen Fieuws ◽

...

Keyword(s):

Pilot Study ◽

Primary Tumour ◽

Distant Metastases ◽

Whole Body ◽

Diffusion Weighted Mri ◽

Diffusion Weighted

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Non-operative management of the primary tumour in patients with incurable stage IV colorectal cancer

Annales de Chirurgie ◽

10.1016/s0003-3944(01)00683-6 ◽

2002 ◽

Vol 127 (1) ◽

pp. 79

Keyword(s):

Colorectal Cancer ◽

Primary Tumour ◽

Stage Iv ◽

Operative Management ◽

Stage Iv Colorectal Cancer ◽

Non Operative Management

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Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection

International Journal of Colorectal Disease ◽

10.1007/s00384-015-2305-8 ◽

2015 ◽

Vol 30 (10) ◽

pp. 1357-1363 ◽

Cited By ~ 6

Author(s):

Javier Suárez ◽

Gabriel Marín ◽

Ruth Vera ◽

Begoña Oronoz ◽

Fabiola Oteiza ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Tumour ◽

Stage Iv ◽

Tumour Resection ◽

Stage Iv Colorectal Cancer ◽

Primary Tumour Resection

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Evaluation of Clinical Prognostic Factors and Further Delineation of the Effect of Mesenteric Fibrosis on Survival in Advanced Midgut Neuroendocrine Tumours

Neuroendocrinology ◽

10.1159/000493317 ◽

2018 ◽

Vol 107 (3) ◽

pp. 292-304 ◽

Cited By ~ 15

Author(s):

Faidon-Marios Laskaratos ◽

Martin Walker ◽

Dominic Wilkins ◽

Alexander Tuck ◽

Shashank Ramakrishnan ◽

...

Keyword(s):

Prognostic Factors ◽

Large Scale ◽

Neuroendocrine Tumours ◽

Primary Tumour ◽

Stage Iv ◽

Epidemiological Data ◽

Tumour Resection ◽

Carcinoid Heart Disease ◽

Factors Affecting ◽

Stage Iv Disease

Background: Small intestinal neuroendocrine tumours (SI NETs) represent 30–50% of small bowel neoplasms and often present at an advanced stage. To date, there is relatively limited literature regarding prognostic factors affecting overall survival (OS) in stage IV disease. In addition, the prevalence of mesenteric fibrosis (MF) in SI NETs and its effect on OS have not been sufficiently explored in the literature. Aim: The primary aim of this study was to perform a large-scale survival analysis in an institutional cohort of 387 patients with metastatic (stage IV) SI NETs. The secondary aim was to provide epidemiological information regarding the prevalence of MF and to evaluate its effect on OS. Results: The median OS was 101 months (95% CI 84, 118). Age > 65 years, mesenteric metastases with and without desmoplasia, liver metastases, carcinoid heart disease (CHD) and bone metastases were associated with a significantly shorter OS, while primary tumour resection was predictive of a longer OS. The benefit of surgical resection was limited to symptomatic patients. MF was present in approximately 50% of patients with mesenteric lymphadenopathy. Elevated urinary 5-HIAA levels correlated strongly with the presence of CHD (p < 0.001) and to a lesser extent (p = 0.02) with MF. MF and CHD did not usually co-exist, suggesting that different mechanisms are likely to be involved in the development of these fibrotic complications. Conclusions: This study has identified specific prognostic factors in a large cohort of 387 patients with advanced SI NETs and has provided useful epidemiological data regarding carcinoid-related fibrotic complications.

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The clinicopathological and survival analysis of urological mucosal melanoma: A single-center retrospective observational study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21588 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21588-e21588

Author(s):

Bixia Tang ◽

Xieqiao Yan ◽

Zhihong Chi ◽

Siming Li ◽

Chuanliang Cui ◽

...

Keyword(s):

Urinary Tract ◽

Regional Lymph Node ◽

Stage Iv ◽

Staging System ◽

Tnm Staging ◽

Mucosal Melanoma ◽

Future Research ◽

Molecular Characteristics ◽

Urethral Carcinoma ◽

Tnm Staging System

e21588 Background: Primary mucosal melanoma arising in the urinary tract is rare and poorly characterized. Methods: The records of patients with urological mucosal melanoma who presented to the department of Renal Cancer and Melanoma of Peking University Cancer Hospital between September, 2004 and April, 2019 were reviewed. Available clinicopathological and molecular characteristics were summarized, including pathological parameters, gene mutation, primary surgical intervention, systemic treatment and clinical course. The rates of local recurrence rate, loco-regional lymph node metastasis and distant metastasis were assessed. American Joint Committee on Cancer (AJCC) TNM Staging System for bladder cancer/renal pelvis and ureter cancer/urethral carcinoma (8th ed., 2017) were adopted for staging. Results: Fifty-eight patients were involved in the study with a median age of 62.5 years (range: 32-82). The anatomic sites of the primary urological mucosal melanomas were from the urethra (89.7%), bladder (6.9%), ureter (0%) and kidney (0%), and the left (4.4%) were from multiple loci. At initial diagnosis, 75.9% (n=44) were stage I/II disease, 1.7% (n=1) stage III, and 22.4% (n=13) stage IV. There was 3.4% incidence of CKIT mutation and 1.7% of BRAF mutation. After median follow-up of 22.6 mo, 31.4% (16/51) relapsed locally after organ-preserved surgery. 21.6% (11/51) and 39.2% (20/51) developed metastases to reginal lymph nodes and distance, respectively. The median relapse free survival and median overall survival were 12.2 (95%CI: 7.9-16.4) mo and 33.9 (95%CI: 19.2-48.6) mo, respectively. Univariate Cox analysis showed that TNM stage and systemic adjuvant therapy were the prognostic factors of OS, while no association was found with Breslow thickness, miotic rate, ulceration and gender. Conclusions: Urological mucosal melanoma predominantly arises from lower urinary tract with rare BRAF and CKIT mutation. AJCC TNM Staging System for urothelial carcinoma is proved practical for urothelial melanoma, which should be validated in larger population. Future research is required to identify adjuvant treatment approaches to improve disease outcomes.

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Inoperable stage IV colorectal cancer with intact primary tumor in patients receiving palliative chemotherapy: Does the response to chemotherapy correlate between primary and metastatic sites? An Irish cancer center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.136 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 136-136

Author(s):

Ruba Hamed ◽

Ronan Andrew McLaughlin ◽

Hatim Ibrahim ◽

Greg Korpanty ◽

Nemer Osman

Keyword(s):

Stable Disease ◽

Primary Tumour ◽

Stage Iv ◽

Primary Site ◽

First Line ◽

Tumour Site ◽

Response To Chemotherapy ◽

Stage 4 ◽

Metastatic Sites ◽

Line Chemotherapy

136 Background: Colorectal cancer (CRC) is the 3rd most common malignancy in Ireland with over 2700 cases annually. Approximately 20% are diagnosed with stage IV disease. The aim of this study is to evaluate the response to chemotherapy at primary and metastatic sites and review the frequency of intervention required to palliate the intact primary tumour in patients with stage 4 inoperable CRC in an Irish tertiary referral centre. Methods: A retrospective review of medical records was completed, identifying stage 4 CRC patients with primary tumour in situ diagnosed between January 2014 and December 2019, treated with chemotherapy (oxaliplatin or irinotecan based +/- bevacizumab or EGFR monoclonal antibody). Data and survival analysis were obtained using Kaplan-Meier methods. Results: 50 eligible patients were identified; 60% male, 40% female with a median age of 62 years. 2% had a transverse colonic primary, 32% right and 44% left sided and 22% had a rectal primary. 36% presented with liver metastasis only, 4% lung metastasis alone and 20% both. 48% were KRAS, 4% NRAS and 4% BRAF mutation positive while 1 patient was identified as having microsatellite instability. All patient received first-line chemotherapy either oxaliplatin or irinotecan based, 18% with the addition of Bevacizumab and 24% with EGFR monoclonal antibody. Overall response to first-line chemotherapy at the primary site and metastatic sites was assessed radiologically; 42% displaying a partial response, 36% had stable disease while 18% had progression at primary site. At the metastatic sites 50% responded, 10% stable disease and 40% progressed. Complication at primary tumour site included: obstruction 12%, with perforation in 6%, bleeding 10%, pain at tumour site in 6%, and one patient developed an abscess. Overall, after chemotherapy 76% of all patients did not require further intervention to manage primary site. 6% underwent curative surgery with resection of primary and metastatic lesions. Of those who had palliative intervention; 10% underwent palliative colostomy/ileostomy, 12% palliative radiotherapy, and 2% both. Overall survival was 14 months. At time of analysis 14% were alive, 10% receiving treatment and 4% on radiological surveillance. Conclusions: This retrospective study confirms that palliative chemotherapy +/- targeted therapy is effective in controlling the primary tumour in stage 4 inoperable CRC. In addition, it reveals a nearly 80% partial response or stable disease radiologically at the primary site after first-line chemotherapy. Furthermore, progression was significantly lower at primary site compared to distant metastasis (18% vs 40%). Almost 75% did not require palliative intervention for their primary tumour. Overall survival in our centre is higher compared to internationally observed data.

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