Abstract
7536 Background: Systemic therapy of stage IV uveal melanoma (mel) is not thought to improve survival. In selected patients (pts), local therapy of metastases (mets) (e.g. surgery or intrahepatic therapy) can be associated with long-term survival. The natural history of stage IV mel is heterogeneous and not well-described. We were interested in describing the natural history and factors that correlate with long-term survival in the stage IV uveal mel pts seen at our institution. Methods: A retrospective analysis of the 119 stage IV uveal mel pts in the MSKCC mel database. We recorded dates of initial diagnosis, stage IV, last follow up, and death; site of 1st met, how the 1st met was discovered, treatment. Results: 40 pts were still alive at last follow up (median follow up of survivors = 8 months). Median overall survival was 12.5 months (95% CI 9.6–16.8). 22% were alive at 4 years. A novel observation was that 28% of the pts had lung/soft tissue only as the site of first metastasis. In a multivariate analysis, we found 3 variates that correlated independently with prolonged survival: Lung or soft tissue as only site of first metastasis (p=.03, HR 0.55, CI .32-.95), treatment with surgery or intrahepatic therapy (p=.005, HR 0.38, .22-.65), and time interval from diagnosis to stage IV uveal mel (p=.03). Whether stage IV mets were first discovered by screening tests (CT scans, blood tests routine physical exam) or by symptoms did not correlate with the likelihood of having surgery or with overall survival. Conclusions: Pts with lung/soft tissue only as the site of first metastasis, pts who are treated with local therapy (surgery or intrahepatic therapy), and pts with longer time interval from initial diagnosis to stage IV have longer survival after stage IV uveal mel is diagnosed. There appeared to be no survival advantage in discovering asymptomatic stage IV uveal mel. Hopefully this will change with improved systemic treatments. No significant financial relationships to disclose.
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