Surveillance testing for metastasis from primary uveal melanoma and effect on patient survival.

PURPOSE To evaluate the quality of evidence about effectiveness of regular periodic surveillance testing for metastasis in patients with primary uveal melanoma (PUM) following treatment of the primary tumor in prolonging survival. DESIGN Literature review and personal perspective of the authors. METHODS Identification and analysis of peer-reviewed articles on human PUM published between 1980 and 2009 that reported on "screening," "surveillance," or "systemic follow-up evaluation" for metastasis in patients with PUM following treatment of primary tumor. RESULTS Of 4222 identified articles, only 31 were considered satisfactory for inclusion in this study. Satisfactory articles reported levels of specific biomarkers when metastasis was first confirmed (14), percentage of patients with abnormal results on surveillance testing (13), values of diagnostic markers (eg, sensitivity, specificity) associated with evaluated components of a surveillance regimen (7), survival time after first detection of metastasis from primary uveal melanoma (7), total survival time after initial diagnosis or initial treatment of primary uveal melanoma (3), percentage of patients whose metastatic tumors were detected by presymptomatic testing (5), surveillance regimens employed by different groups (1), and relationship with generally accepted clinical and histopathologic prognostic factors for primary uveal melanoma metastasis (1). However, none of these articles reported survival times of comparable subgroups of patients in which regular periodic surveillance for metastasis vs no surveillance was performed. CONCLUSION Available evidence from the peer-reviewed literature does not provide any compelling evidence of survival benefit for any regimen or frequency of surveillance for metastasis relative to no such testing. In view of this, advisability of periodic surveillance for metastasis in routine clinical practice must be questioned.