The long-term prognosis in uveal melanoma may be better than expected

Uveal melanoma is the most common malignant eye tumor in adults. A large proportion of patients develop metastases and die from their disease, but previous reports on the size of this proportion vary considerably. A systematic review and meta-analysis now estimates the size of this proportion.
Published in Cancer
The long-term prognosis in uveal melanoma may be better than expected
Like

Introduction

Melanomas of the uvea are the most common primary intraocular malignant tumors in adults, affecting more than 7000 individuals each year worldwide. Eventually, a large proportion of patients develop distant metastases after which median survival is about one year. Currently available treatment options for primary tumors have limited effect on patient survival.

Estimations of the proportion of patients that develop metastases vary considerably.
It is often stated that one half of patients will die from their disease. Other publications report significantly lower mortality rates in the range of 20 to 25 % for patients with similar patient baseline characteristics over similar periods of time. The reason for this variance may at least partially be found in dissimilarities in the methods used for calculation of mortality rates. No method for calculating survival is without flaws, but some methods may be less suitable than others:

  • Actuarial methods including life tables and Kaplan-Meier estimates are excellent for evaluation of all-cause mortality but are likely to overestimate disease-specific mortality in the presence of competing risks.
  • Cumulative incidences of melanoma-related mortality rely on accurate classifications of the cause of death. This has relatively small impact when studying diseases with low mortality, but may be more biased in studies of a disease with a mortality that approaches 50 %. 
  • Relative survival, in which the observed overall survival of a cancer population is divided by the overall survival in a reference population without the cancer is less prone to bias provided that 1) the sample size is sufficiently large, 2) that the disease is rare in the general population, and 3) that the disease does not have risk factors that are strongly associated with other causes of death (e.g. smoking). Analysis of relative survival may therefore be well suited for uveal melanomas.

What we did

What we found

Nine studies and a total of 18 495 patients were included. The 30-year relative survival rates followed a u-shaped curve that was well fitted to data from random-effects inverse-variance and weighted average models. The estimated five, ten, 15, 20, 25 and 30-year relative survival rates wee 79, 66, 60, 60, 62 and 67 %, respectively.

Why our findings are important

About two in five patients with uveal melanoma succumb to their disease within 20 years after primary tumor treatment. This indicates a slightly better prognosis than what is often assumed, and that patients surviving 20 years or longer may even have a survival advantage to individuals of the same sex and age from the general population. This is useful when we counsel our patients and their relatives.

Please sign in or register for FREE

If you are a registered user on Research Communities by Springer Nature, please sign in

Subscribe to the Topic

Cancer Biology
Life Sciences > Biological Sciences > Cancer Biology

Related Collections

With collections, you can get published faster and increase your visibility.

Precision medicine in diabetes

This Collection includes a series of systematic reviews published by the ADA/EASD Precision Medicine in Diabetes Initiative consortium and is also open to other submissions on precision diabetes medicine.

Publishing Model: Open Access

Deadline: Apr 25, 2024

Liquid biopsy

This Collection welcomes clinical and translational research on liquid biopsy approaches in cancer.

Publishing Model: Open Access

Deadline: May 13, 2024