{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:37:08Z","timestamp":1792661828160,"version":"4.5.0"},"reference-count":65,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T00:00:00Z","timestamp":1657238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","award":["20 0798 Fk"],"award-info":[{"award-number":["20 0798 Fk"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018666","name":"Carmen and Bertil Regn\u00e9r's Foundation","doi-asserted-by":"publisher","award":["2020\u201000062"],"award-info":[{"award-number":["2020\u201000062"]}],"id":[{"id":"10.13039\/100018666","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","award":["2020\u2010013333"],"award-info":[{"award-number":["2020\u2010013333"]}],"id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","award":["2020\u201002517"],"award-info":[{"award-number":["2020\u201002517"]}],"id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001725","name":"Royal Swedish Academy of Sciences","doi-asserted-by":"publisher","award":["ME2019\u20100036"],"award-info":[{"award-number":["ME2019\u20100036"]}],"id":[{"id":"10.13039\/501100001725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To revisit\u00a0the independent importance of ciliary body involvement (CBI), monosomy 3 (M3), tumour size, histological and clinical factors in uveal melanoma (UM) and to devise a new prognostic classification based on a combination of the American Joint Committee on Cancer (AJCC) and the Cancer Genome Atlas (TCGA) models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two cohorts with a total of 1796 patients were included. Clinicopathological factors were compared between patients with and without CBI and M3. Development of the prognostic classification was performed in a training cohort and was then tested in two independent validation cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Tumours with CBI were more common in women, had greater apical thickness, greater basal tumour diameter, greater rates of vasculogenic mimicry and greater rates of M3, were more often asymptomatic at diagnosis and had poorer 5\u2010 and 10\u2010year globe conservation rates (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.023). In multivariate logistic regression, patient age at diagnosis, tumour diameter and CBI were independent predictors of M3 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In multivariate Cox regression, male sex, age at diagnosis, tumour diameter, M3 and CBI were independent predictors of metastasis. The proposed prognostic classification combined patient age, sex, CBI, extraocular extension, M3, 8q (optional) and tumour size, and demonstrated greater prognostic acumen than both AJCC 4 T categories and TCGA groups A to D in validation cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Tumour size does not confound the prognostic implication of CBI, M3, male sex and age at diagnosis in UM. These factors were included in a new prognostic classification that outperforms AJCC T category and TCGA groups.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.15210","type":"journal-article","created":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T07:47:13Z","timestamp":1657266433000},"page":"34-48","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["A prognostic classification system for uveal melanoma based on a combination of patient age and sex, the American Joint Committee on Cancer and the Cancer Genome Atlas models"],"prefix":"10.1111","volume":"101","author":[{"given":"Viktor T.","family":"Gill","sequence":"first","affiliation":[{"name":"Department of Pathology V\u00e4stmanland Hospital V\u00e4ster\u00e5s  V\u00e4ster\u00e5s Sweden"},{"name":"Department of Clinical Neuroscience, Division of Eye and Vision Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiva","family":"Sabazade","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Division of Eye and Vision Karolinska Institutet  Stockholm Sweden"},{"name":"St. Erik Eye Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Herrspiegel","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Division of Eye and Vision Karolinska Institutet  Stockholm Sweden"},{"name":"St. Erik Eye Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn G.","family":"Ewens","sequence":"additional","affiliation":[{"name":"Department of Genetics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrianna","family":"Opalko","sequence":"additional","affiliation":[{"name":"St. Erik Eye Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Dan","sequence":"additional","affiliation":[{"name":"St. Erik Eye Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinna","family":"Christersdottir","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Division of Eye and Vision Karolinska Institutet  Stockholm Sweden"},{"name":"St. Erik Eye Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Berg Rendahl","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Division of Eye and Vision Karolinska Institutet  Stockholm Sweden"},{"name":"St. Erik Eye Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol L.","family":"Shields","sequence":"additional","affiliation":[{"name":"Ocular Oncology Service, Wills Eye Hospital Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Seregard","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Division of Eye and Vision Karolinska Institutet  Stockholm Sweden"},{"name":"St. Erik Eye Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arupa","family":"Ganguly","sequence":"additional","affiliation":[{"name":"Department of Genetics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9401-8911","authenticated-orcid":false,"given":"Gustav","family":"St\u00e5lhammar","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Division of Eye and Vision Karolinska Institutet  Stockholm Sweden"},{"name":"St. Erik Eye Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19901001)66:7<1596::AID-CNCR2820660726>3.0.CO;2-6"},{"key":"e_1_2_7_3_1","first-page":"6541","article-title":"Clinical, histopathological and cytogenetic prognosticators in uveal melanoma \u2013 a comprehensive review","volume":"37","author":"Berus T.","year":"2017","journal-title":"Anticancer Research"},{"key":"e_1_2_7_4_1","first-page":"360","article-title":"Ciliary body melanoma \u2013 a particularly rare type of ocular tumor. Case report and general considerations","volume":"8","author":"Costache M.","year":"2013","journal-title":"Maedica (Bucur)"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2009.235"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2018.09.024"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.13-12195"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-017-02428-w"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2020.11.023"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0046-8177(92)90299-I"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2021.11.018"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1996.01100140318011"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1194472"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng.2523"},{"key":"e_1_2_7_15_1","first-page":"1370","article-title":"Uveal melanoma, hormonal and reproductive factors in women","volume":"51","author":"Holly E.A.","year":"1991","journal-title":"Cancer Research"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19930201)71:3<811::AID-CNCR2820710325>3.0.CO;2-F"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2018.03.011"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-020-0158-0"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-16276-8"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2016.275"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-40265-7"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.45.2771"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2004.11.063"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.118.8.1066"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/91.4.359"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.07.016"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng.2674"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2019.5710"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(82)80116-0"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(97)30234-6"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.06-1308"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-04-1750"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.08-2145"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.16-20077"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/82.22.1765"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)90736-9"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.02.6534"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2017.07.003"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2019.5403"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(95)30947-5"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-021-03851-9"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-021-09002-0"},{"key":"e_1_2_7_43_1","first-page":"88","article-title":"Iridociliary melanoma \u2010 Clinical case","volume":"9","author":"Schmitzer S.","year":"2016","journal-title":"Journal of Medicine and Life"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.02-0159"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1983.01040020896012"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(98)93032-9"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1001\/archophthalmol.2009.208"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.125.8.1017"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0b013e31824d09a8"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.04.003"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.12.026"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2014.5395"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1002\/gcc.2870020307"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-2264(199705)19:1<22::AID-GCC4>3.0.CO;2-2"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1159\/000497186"},{"key":"e_1_2_7_56_1","first-page":"502","article-title":"Density of PAS positive patterns in uveal melanoma: correlation with vasculogenic mimicry, gene expression class, BAP\u20101 expression, macrophage infiltration, and risk for metastasis","volume":"25","author":"Stalhammar G.","year":"2019","journal-title":"Molecular Vision"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.07.018"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/427163"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-88390-6"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.13-13670"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature07586"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1000584"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.17-22255"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-06-2401"},{"key":"e_1_2_7_66_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.12-10365"}],"container-title":["Acta Ophthalmologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.15210","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aos.15210","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.15210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T13:01:22Z","timestamp":1692536482000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aos.15210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,8]]},"references-count":65,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1111\/aos.15210"],"URL":"https:\/\/doi.org\/10.1111\/aos.15210","archive":["Portico"],"relation":{},"ISSN":["1755-375X","1755-3768"],"issn-type":[{"value":"1755-375X","type":"print"},{"value":"1755-3768","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,8]]},"assertion":[{"value":"2022-01-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}