Five Decades of Enucleations for Uveal Melanoma in One Center: More Tumors with High Risk Factors, No Improvement in Survival over Time

Abstract

<b><i>Background:</i></b> In order to improve medical care for uveal melanoma (UM) patients, we need to monitor disease and survival to guide our research efforts. We analyzed the data of UM patients who underwent an enucleation at the Leiden University Medical Center over the last five decades and investigated trends in patient and tumor characteristics and survival. <b><i>Methods:</i></b> Data were collected from charts and pathology reports from all patients who underwent an enucleation for UM between 1973 and 2019 (<i>n</i> = 1,212), of which 1,066 were primary enucleations; data were analyzed according to five time periods: 1973–1979 (<i>n</i> = 209), 1980–1989 (<i>n</i> = 148), 1990–1999 (<i>n</i> = 174), 2000–2009 (<i>n</i> = 280), and 2010–2019 (<i>n</i> = 401). <b><i>Results:</i></b> Over time, mean patient age at the time of enucleation for UM increased from 54.9 to 64.7 years (<i>p</i> < 0.001), more tumors showed histopathological involvement of the ciliary body (<i>p</i> < 0.001), and were classified in a high TNM/AJCC class (<i>p</i> < 0.001). Overall, the 5- and 10-year UM-related survival rates were 0.68 and 0.59, respectively. Over time, survival showed no change in patients with tumors in AJCC stages I or III, with recently a slightly worse survival in stage II UM (<i>p</i> = 0.02). <b><i>Conclusion:</i></b> Between 1973 and 2019, we found similar rates of UM-related survival following enucleation, although we noticed a strong increase in more unfavorable patient and tumor characteristics over time, such as an older age and larger tumor size. The lack of improvement indicates that more research should take place to develop adjuvant treatments to prevent metastases and efficient treatments once metastases develop.

Iris Colour and the Risk of Developing Uveal Melanoma

“…An earlier diagnosis was associated with a better prognosis [39]. Neither this increase in incidence nor an improvement in survival has been observed in UM [40].…”

Adding the Cancer Genome Atlas Chromosome Classes to American Joint Committee on Cancer System Offers More Precise Prognostication in Uveal Melanoma

“…However, the rate of metastasis formation remains high and, over the past five decades, there has not been an improvement in UM-specific survival. 1,5,6 Similar to the situation in cutaneous melanoma, adjuvant therapies are in development, which can target high risk patients. For this, it is vital to optimally identify which patients are at high risk of metastasis and of UM-related death.…”

LAG3 and Its Ligands Show Increased Expression in High-Risk Uveal Melanoma

“…Uveal melanoma (UM) is a rare ocular malignancy which is especially seen in people with a fair skin and light eyes [1,2]. Up to 50% of patients develop metastases and no improvement in survival has occurred over the last 50 years [3,4]. The presence of an inflammatory phenotype is associated with a bad prognosis and involves the presence of a mixed leukocytic infiltrate, which is made up of tumour-infiltrating lymphocytes (TIL), tumour-associated macrophages (TAM), and an increased HLA class I and II expression [5][6][7][8][9].…”