Survival Rates in Patients After Treatment for Metastasis From Uveal Melanoma

Abstract

IMPORTANCE Despite high rates of local tumor control in patients who are treated for uveal melanoma, most patients will eventually die of metastasis. When metastasis develops, the liver is involved in most cases, and hepatic metastases are particularly refractory to treatment. Finding effective treatments has been challenging. A comparison of survival rates in patients who were treated for metastasis over approximately 30 years may offer insights into progress that has been made in prolonging survival. OBJECTIVE To compare survival after treatment for metastasis in a cohort of patients who were treated for uveal melanoma at the Massachusetts Eye and Ear Infirmary (MEE) during an approximately 30-year period with an earlier analysis to determine if there was meaningful improvement in survival rates after treatment for metastasis. DESIGN, SETTING, AND PARTICIPANTS This review included patients (n = 661) who received a diagnosis of metastasis from uveal melanoma who were identified from a cohort of 3063 patients treated at MEE between January 1982 and December 2009 and followed up through December 2011. They were compared with findings from a previous study of patients treated between 1975 and 1987. MAIN OUTCOMES AND MEASURES Survival rates in patients who received treatment for metastasis were compared with those who did not receive treatment. The differences in survival rates were compared with an earlier analysis that was completed at MEE. A comparison of patients with hepatic metastases and extrahepatic metastases was also completed. Kaplan-Meier analysis was used to calculate survival rates and the log rank test was used to test for statistically significant differences between the groups. RESULTS Of 620 patients with race information available, 615 (97.3%) were white; the mean (SD) age of patients was 59.71 (13.23) years and 307 (47.3%) were women. The median time from the initial treatment of the tumor to metastasis was 3.45 years (interquartile range [IQR], 2.0-5.57). Overall, the median survival time was poor (3.9 months [IQR, 1.6-10.1]). Patients who received treatment fared better than those who did not receive treatment (median survival after metastasis diagnosis, 6.3 months [IQR, 2.96-14.41] vs 1.7 months [IQR, 0.66-3.5]). This finding was similar to that of our earlier study in which median survival was 5.2 months and 2 months for treated and untreated patients, respectively. CONCLUSIONS AND RELEVANCE These findings suggest that advances in treatments that lead to clinically meaningful improvements in survival times have not been realized. Similar survival rates in patients who were treated for metastasis were observed in this recent analysis compared with our earlier study. Adjuvant therapies that are initiated at the time of melanoma diagnosis may be the most effective way to prolong survival.

Metastatic uveal melanoma managed with best supportive care

“…Also, to the best of our knowledge, our cohort is the second largest one of patients receiving BSC for metastatic UM, and we are the first to stage them. We are aware of seven previous reports that included 11 to 191 patients with BSC [9,[20][21][22][23][24][25]. One of these studies also analysed prognostic factors and found, in line with us, that patients who received BSC had worse PS than actively treated [23].…”

Expression of P16INK4a in Uveal Melanoma: New Perspectives

“…Uveal melanoma is a rare neoplasia characterized by unpredictable behavior, and, despite the illusory success of local therapies, more than 50% of patients develop metastases within 5 years from diagnosis ( 31 ). Less than 4% of UM patients present metastases concomitant with the primary disease, but the high metastatic rate suggests that clinically undetectable metastases might be present upon diagnosis.…”

The national comprehensive cancer network distress thermometer as a screening tool for the evaluation of quality of life in uveal melanoma patients

“…Uveal melanoma is the most frequent primary intraocular tumour in adults (Singh & Topham 2003) with a reported incidence of 5-7 per million (Hu et al 2005) and must be considered as a severe ocular and, due to the risk of the development of metastases, possibly life-threatening condition (Lane et al 2018). To date, good local tumour control can be achieved in the vast majority of cases (Gragoudas et al 1992) using different techniques from eye-conserving plaque brachytherapy, proton beam therapy, stereotactic radiosurgery to enucleation.…”