Abstract
The long-term survival of uveal melanoma patients in the US is not known. We compared long-term survival estimates using relative survival, excess absolute risk (EAR), Kaplan-Meier (KM), and competing risk analyses. Population based cohort study. Pooled databases from Surveillance, Epidemiology, and End Results data (SEER, SEER-9+SEER-13+SEER-18). Overall Survival (OS), Metastasis Free Survival (MFS) and relative survival, computed directly or estimated via a model fitted to excess mortality. There were 10678 cases of uveal melanoma spanning a period of 42 years (1975-2016). The median age at diagnosis was 63 years (range 3-99). Over half the patients were still alive at the end of 2016 (53%, 5625). The KM estimates of MFS were 0.729 (0.719, 0.74), 0.648 (0.633, 0.663), and 0.616 (0.596, 0.636) at 10, 20, and 30 years, respectively. The cumulative probabilities of melanoma metastatic death at 10, 20 and 30 years were 0.241 (0.236, 0.245), 0.289 (0.283, 0.294), and 0.301 (0.295, 0.307). In the first 5 years since diagnosis of uveal melanoma, the proportion of deaths attributable to uveal melanoma were 1.3 with rapid fall after 10 years. Death due to melanoma were rare beyond 20 years. Relative survival (RS) plateaued to ~60% across 20 to 30 years. EAR parametric modeling yielded a survival probability of 57%. Relative survival methods can be used to estimate long term survival of uveal melanoma patients without knowing the exact cause of death. RS and EAR provide more realistic estimates as they compare the survival to that of a normal matched population. Death due to melanoma were rare beyond 20 years with normal life expectancy reached at 25 years after primary therapy.
Highlights
There is a paucity of uveal melanoma survival data beyond 15 years
There were 10678 cases of uveal melanoma spanning a period of 42 years (1975–2016)
Death due to melanoma were rare beyond 20 years with normal life expectancy reached at 25 years after primary therapy
Summary
There is a paucity of uveal melanoma survival data beyond 15 years. A multicenter collaborative effort to develop American Joint Commission on Cancer (AJCC) staging for uveal melanoma reported that 19% of patients had died due to metastatic melanoma at 10 years [1]. Beyond 15 years following ocular treatment, cohort thinning presents challenges [5,6,7]. Large population-based datasets with long-term follow up are needed to assess long-term survival in uveal melanoma patients [8, 9]. In a Danish study of 302 patients diagnosed in 1943–1952, 50% died of uveal melanoma at 25 years [8]. In a Finnish study of 289 patients diagnosed in 1962–1981, 52% died of uveal melanoma at 35 years [9]. We add new US estimates based on Surveillance, Epidemiology, and End Results (SEER) cases diagnosed in 1975–2016
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