Prognostic factors for survival after enucleation for choroidal and ciliary body melanomas

Abstract

ABSTRACT.Purpose: To evaluate prognostic factors for the survival of patients treated by enucleation for choroidal and ciliary body melanomas. Methods: The study included 293 consecutive patients (147 men and 146 women) treated by enucleation for a choroidal or ciliary body melanoma during the period 1955-2000. The median age at treatment was 61 years (range 26-88 years). Clinical and histopathological findings, vital status at October 1st, 2002, and cause of death were registered. Prognostic factors for survival were evaluated by univariate and multivariate Cox proportional hazards analysis and by Kaplan-Meier survival analysis. Results: Follow-up was complete. The median follow-up time was 6.2 years (range 21 days to 43.4 years) and the median potential follow-up time was 25.7 years (range 1.9-47.7 years). In multivariate Cox proportional hazards analysis an increased risk of melanoma-related death was found for largest basal diameter (n ¼ 264, p < 0.001, mortality rate ratio (RR) ¼ 1.09 for continuous parameter in mm), anterior tumour margin at the iris/ciliary body versus choroid (p < 0.001, RR ¼ 2.22), and non-spindle cell type versus spindle cell (p ¼ 0.047, RR ¼ 1.45). An increased risk of death from all causes was found for men versus women (n ¼ 266, p ¼ 0.02, RR ¼ 1.41), high age (p < 0.001, RR ¼ 1.41 for continuous parameter in 10-year age groups), largest basal diameter (p < 0.001, RR ¼ 1.07), anterior tumour margin at the iris/ciliary body (p ¼ 0.02, RR ¼ 1.52), and non-spindle cell type (p ¼ 0.04, RR ¼ 1.34). Conclusion: The risk of melanoma-related death after enucleation for a choroidal or ciliary body melanoma was high for tumours with large basal diameter, of non-spindle cell type and anterior location. Additional risk factors for death from all causes were male sex and high age.

Differences in uveal melanomas between men and women from the British Isles

“…5,6 UMs affect both sexes in equal numbers, but males have been reported to show higher disease-specific mortality. 7,8 Lower survival rates in males have also been reported in cutaneous melanoma. 9 This is believed to correlate with more aggressive histology in males.…”

A reappraisal of the significance of largest basal diameter of posterior uveal melanoma

“…[7][8][9] Largest tumour diameter is currently the most widely used predictor of metastatic disease. 4,[10][11][12][13][14] This factor also correlates with extraocular spread and hence chances of orbital recurrence. 5,15 After conservative therapy, LTD is associated with increased risk of local tumour recurrence, exudative retinal detachment, neovascular glaucoma, and other ocular complications.…”

Posterior uveal melanoma treated with I-125 brachytherapy or primary enucleation

“…2,9,18,22,23 Several studies have shown that the size of the uveal melanoma is a risk factor for subsequent metastases. 22,24,25 In the multivariate analyses, we found that large basal tumour diameter was the only significant predictive factor for metastatic disease. The differences in tumour size could therefore explain the difference between the mortality curves in the two treatment groups.…”