Impact of Therapy & Age in Choroidal Cancers: A Retrospective Cohort Analysis of 7722 Patients from a US National Database

Abstract

Background Collectively, choroidal cancers represent a vast array of histopathologically diverse constituencies with profound repercussions related to mortality and metastasis. Prognosticated factors provide utility in determining clinical management and outcome propensities. To date, measures to collectively characterize choroidal cancers as a class are not impressive. This study aims to shed light on the affiliation of age and therapeutic modalities to survival in patients diagnosed with choroidal cancers. Methods Cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) program, a freely accessible population-based database, was executed from 1975 to 2016, a 41-year time window. Univariable and multivariable Cox regression assessed survival with age and various therapeutic modalities as primary independent variables. Adjustment for several demographical and clinical variables was performed. Results This cohort consisted of 7722 patients at the time of diagnosis. Multivariable Cox regression demonstrated increased cause-specific hazards of 71.8% for patients aged 75+ years (HR = 1.718, CI 1.155–2.555, p < 0.008) as compared to patients aged 0–24 years. 16.2% and 58.0% increases in cause-specific mortality were showcased in patients diagnosed with 8770/3: mixed epithelioid and spindle cell melanoma (HR = 1.16, p = 0.029) and 8771/3: epithelioid cell melanoma of the choroid (HR = 1.580, p < 0.001) compared to individuals diagnosed with 8720/3: malignant melanoma NOS of the choroid. Chemotherapy significantly influenced survival in patients with choroidal cancers compared to those who did not receive chemotherapy or had an unknown status (HR = 0.377, CI 0.292–0.486, p < 0.001). Conclusion Like most cancers, choroidal cancers showcase poor clinical trajectory with advanced age. Specific ICD-O-3 histological subtypes predispose to increased mortality. Therapeutic modalities such as radioactive implants and chemotherapeutic agents demonstrate decreased cause-specific mortality compared to alternative treatments. Altogether, nuanced influences of age and therapy are revealed when evaluating choroidal cancers as a class, irrespective of subtype.

A Comprehensive Understanding of Choroidal Metastasis from Lung Cancer

“… 38 The cohort analysis conducted by Hussain et al showed that compared with patients who did not receive chemotherapy, chemotherapy significantly affected the survival rate of patients with choroidal cancer (HR = 0.377, 95% CI 0.292–0.486, p < 0.001). 39 Moreover, an Asian retrospective study of 12 patients with CM reported that 66.7% of patients achieved CM regression when treated with chemotherapy alone. 24 Further, studies have reported that the combination of chemotherapy with intravenous bevacizumab may also be effective in cases of intraocular metastases.…”