Liver function tests in metastatic uveal melanoma☆

Abstract 

Purpose

To evaluate trends in liver function tests before detection of liver metastases from uveal melanoma.

Design

Retrospective, comparative, observational case control study.

Methods

Setting: The Israel uveal melanoma center at the Hadassah University Hospital. Patient Population: A total of 307 uveal melanoma patients who were diagnosed with uveal melanoma and followed between the years 1988 and 1998. Of them, 30 metastatic patients who had regular follow-up by liver function tests (LFTs) and liver imaging were included in this study. Eighty nonmetastatic patients were randomly chosen as controls. Observation Procedure: The medical records of the metastatic and control groups were reviewed documenting LFTs and liver imaging results. Main Outcome Measures: The mean level of each LFT, its sensitivity, specificity, and likelihood ratio at various time periods before the detection of metastases by liver imaging.

Results

At the time of diagnosis of liver metastases by imaging, 50% of patients had at least one abnormal LFT (compared with only 5% of the control group). While no change was noted in the mean serum levels of bilirubin, mean lactate dehydrogenase (LDH), alkaline-phosphatase, gamma glutamyl transpeptidase (γGTP) aspartate-aminotrasferase, and alanine-aminotrasferase levels seem to rise, even within normal limits, during the 6 months before the detection of metastases. Based on likelihood ratios, alkaline-phosphatase and lactate dehydrogenase were the most predictive tests. Lactate dehydrogenase and aspartate-aminotransferase were already predictive at 80% of the upper normal limit, whereas alkaline-phosphatase and γ-glutamyltransferase were most predictive at the upper normal limit.

Conclusions

Monitoring the changes in selected LFTs, even within normal limits, can help predict metastatic uveal melanoma.