Survival analysis of patients with uveal melanoma after organ preserving and liquidation treatment

Abstract

Rationale: Uveal melanoma is the most common primary malignancy of the eye. Aim: To evaluate survival in patients with uveal melanoma stratified according to the type of treatment and to identify factors significantly associated with their survival. Materials and methods: The study was performed on the data extracted from medical files and follow-up forms of patients with uveal melanoma seen in the Ophthalmological Clinical Hospital of the Department of Healthcare, Moscow, from 1977 to 2012. Analysis of survival was used to assess the life longevity of patients with uveal melanoma. The analysis was censored at January 2013, when vital status (dead or alive) of all patients was assessed. The factors included into the study analysis, were those taken from the follow-up forms. The incidence of uveal melanoma in Moscow (2012) was 0.9 per 100,000 of the population, whereas its prevalence was 11.1 per 100,000. Results: 698 patients with uveal melanoma were included into the study, among them 260 (37%) men (aged from 19 to 87 years, median age 60 years) and 438 (63%) women (aged from 18 to 93 years, median age 63 years); therefore, the proportion of women under the follow-up monitoring was by 26% higher than that of men. The liquidation treatment (mostly enucleation) was performed in 358 (51%) of the patients, whereas the organ preserving treatment in 340 (49%). At 5, 7, and 10 years of the follow-up, the disease-specific survival of patients with uveal melanoma after the organ preserving treatment (median survival has not been reached) and after the liquidation treatment (median, 88 months) were 89 ± 2, 83 ± 3, and 75 ± 4% versus 63 ± 3, 52 ± 4, and 47 ± 5%, respectively (р = 0.001). Overall survival and disease-specific survival of the patients after the liquidation treatment were significantly lower than in the patients after the organ-preserving treatment. According to multiple regression analysis, this was associated not with the type of treatment, but rather with higher initial grade of the disease (as the most significant factor) and with older age (> 65 years; the second significant factor). Both factors were significantly more prevalent (р = 0.05; chi-square test) among the patients who underwent the liquidation treatment. Conclusion: The large size of the uveal melanoma, with its pre-equator location and extrascleral spread, as well as the age above 65 years can be considered as unfavorable prognostic factors.