ArticlePloS one2026
Systemic surveillance for uveal melanoma: Approach to optimization.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
importanceThere is lack of evidence assessing surveillance protocols to detect metastasis in patients with uveal melanoma (UM).
objectiveTo explore hypothetical surveillance schedules anchored in the real-world data of our patient cohort with known prognostication status wherein, surveillance intervals ranging from every 1-month to every 12-months were statistically analysed.
designRetrospective, cohort study.
settingSingle center.
participantsPatients clinically diagnosed with UM and managed with standard of care local therapy who underwent prognostication by commercially available Gene Expression Profile (GEP) (Castle Biosciences, Friendswood, Texas, USA). Those classified as having low risk (Class 1) were offered a standard protocol (SP; hepatic ultrasonography (US) at 6-month intervals) while those with high risk (Class 2) were recommended to undergo enhanced protocol (EP) that incorporated either higher frequency (US every 3 months) or enhanced modality (EM, hepatic computed tomography/magnetic resonance imaging).
main outcome measuresOptimal scan interval.
results349 patients with median age of 62 years and 54% were male. Most patients were Class 1 (65%) and had choroidal location (75%). Median follow-up among survivors was 30.9 months (IQR: 19-57.9). 67 patients developed metastasis. The 5-year overall survival (OS) was 80% and the 5-year metastasis-free survival (MFS) was 71%. For Class 1 patients, 12-month scan interval was optimal as it had the minimal Euclidean distance to the point (0, 0) with a median of 2.92 months from negative to positive scan with an average of 2.83 scans per patient. For Class 2 patients, a 9-month scan interval was optimal as it minimized the Euclidean distance to the point (0, 0) with an average of 3.09 scans per patients and a median of 2.93 months from negative to positive scans. There was an association between the longer scan interval and size of metastatic lesion (>=6 months versus <6 months, p = 0.002). CONCLUSIONS AND RELEVANCE: Our analysis suggests that the frequency of hepatic imaging for detection of metastasis can be tailored on the risk status to 12 months and 9 months for patients with low and high-risk tumors, respectively. Our study provides a framework for future studies assessing surveillance protocol designs, efficacy, and impact on patient survival.
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