Prolonged survival after complete resection of metastases from intraocular melanoma

Abstract

The median survival time after a diagnosis of metastases from uveal melanoma is 2 to 6 months. Because complete resection of metastatic melanoma from a cutaneous primary can prolong survival, the authors hypothesized that resection also might benefit patients with metastases from an intraocular site. From 1971 to 1999, 112 patients with metastatic melanoma from an intraocular site were enrolled in various treatment protocols after informed consent was obtained. Prospectively recorded clinical variables and follow-up information was retrieved from the patient database. Survival curves were estimated using the Kaplan-Meier method. Univariate analysis was performed with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model. Propensity score analysis was used to reduce the imbalance between subgroups and to assess treatment effect. Seventy-eight patients (70%) presented with hepatic metastases. Twenty-four patients (21%) underwent resection of metastatic lesions. At a median follow-up of 11 months (range, 1 to 97 months; >36 months for survivors), the median survival period was 11 months and the 5-year survival was 7%. Univariate analysis showed that surgical resection, site of metastases, number of metastatic lesions, and disease-free interval were correlated significantly with survival (<i>P</i> < .001, <i>P</i> < .001, <i>P</i> < .001, and <i>P</i> = .031, respectively). Multivariate analysis showed that surgical resection was significant (<i>P</i> = .008) but that the site of metastases was not (<i>P</i> = .146). The median survival and 5-year survival rate were 38 months and 39%, respectively, for surgical patients, vs 9 months and 0%, respectively, for nonsurgical patients. After adjusting for covariate imbalance by propensity score analysis, surgery remained significant (<i>P</i> = .021) on multivariate analysis. Complete surgical resection may prolong survival in certain patients with distant metastases from intraocular primary melanoma. However, the overall unfavorable prognosis indicates an urgent need for more effective nonsurgical interventions.—Hans E. Grossniklaus