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.
- 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.
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