Risk factors, clinical outcomes, and natural history of uveal melanoma: a single-institution analysis

Glenda M. Delgado-Ramos, Fridtjof Thomas, Vanderwalde Ari, Benjamin King, Matthew Wilson, Arnel M. Pallera

Research output: Contribution to journalArticle

Abstract

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. We describe the characteristics of UM patients at a tertiary referral center in the Mid-Southern United States, and explore associations and predictors of outcomes. This is a retrospective cohort study of patients with UM seen at West Cancer Center, from 07/2006 to 08/2017. Clinical characteristics and their relationship to outcomes (time-to-death and metastasis) were explored using Cox regression analysis. We identified 208 patients, 51% males, 97% Caucasians, 80% were symptomatic, with a median follow-up of 2.34 years, IQR (1.01–3.03), of which 19.2% died during follow-up. Metastases were diagnosed in 19% (4 older patients had metastases at diagnosis), 53% of those by surveillance. Without considering metastases as a time-varying covariate, age (HR = 1.06/year, CI 1.0–1.1; p < 0.001), headaches (HR = 5.7, CI 1.6–20.5; p = 0.03), and tumor stage (T) were significant covariates for time-to-death. Tumor stages T3 versus T1 (HR = 6.4; CI 1.5–27.7; p = 0.01) and T4 versus T1 (HR = 5.98; CI 1.3–27.8; p = 0.02) were associated with worse outcomes. When considering metastases as a time-varying covariate (HR = 35.8, CI 17–75.2; p < 0.001), only age remains in the model (HR = 1.04/year; p < 0.001). However, tumor stage (p < 0.001), headaches (p = 0.008), and age (p < 0.001) are associated with time-to-metastasis. One in five patients developed metastasis which was the most influential factor on mortality. Predictors of mortality were metastasis, age, tumor stage, and headache as a reported symptom. Surveillance successfully diagnosed metastatic disease in most patients. Most patients had symptoms preceding their UM diagnosis highlighting an opportunity for earlier recognition of UM.

Original languageEnglish (US)
Article number17
JournalMedical Oncology
Volume36
Issue number2
DOIs
StatePublished - Feb 1 2019

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Natural History
Neoplasm Metastasis
Headache
Neoplasms
Mortality
Uveal melanoma
Tertiary Care Centers
Cohort Studies
Retrospective Studies
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Risk factors, clinical outcomes, and natural history of uveal melanoma : a single-institution analysis. / Delgado-Ramos, Glenda M.; Thomas, Fridtjof; Ari, Vanderwalde; King, Benjamin; Wilson, Matthew; Pallera, Arnel M.

In: Medical Oncology, Vol. 36, No. 2, 17, 01.02.2019.

Research output: Contribution to journalArticle

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abstract = "Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. We describe the characteristics of UM patients at a tertiary referral center in the Mid-Southern United States, and explore associations and predictors of outcomes. This is a retrospective cohort study of patients with UM seen at West Cancer Center, from 07/2006 to 08/2017. Clinical characteristics and their relationship to outcomes (time-to-death and metastasis) were explored using Cox regression analysis. We identified 208 patients, 51{\%} males, 97{\%} Caucasians, 80{\%} were symptomatic, with a median follow-up of 2.34 years, IQR (1.01–3.03), of which 19.2{\%} died during follow-up. Metastases were diagnosed in 19{\%} (4 older patients had metastases at diagnosis), 53{\%} of those by surveillance. Without considering metastases as a time-varying covariate, age (HR = 1.06/year, CI 1.0–1.1; p < 0.001), headaches (HR = 5.7, CI 1.6–20.5; p = 0.03), and tumor stage (T) were significant covariates for time-to-death. Tumor stages T3 versus T1 (HR = 6.4; CI 1.5–27.7; p = 0.01) and T4 versus T1 (HR = 5.98; CI 1.3–27.8; p = 0.02) were associated with worse outcomes. When considering metastases as a time-varying covariate (HR = 35.8, CI 17–75.2; p < 0.001), only age remains in the model (HR = 1.04/year; p < 0.001). However, tumor stage (p < 0.001), headaches (p = 0.008), and age (p < 0.001) are associated with time-to-metastasis. One in five patients developed metastasis which was the most influential factor on mortality. Predictors of mortality were metastasis, age, tumor stage, and headache as a reported symptom. Surveillance successfully diagnosed metastatic disease in most patients. Most patients had symptoms preceding their UM diagnosis highlighting an opportunity for earlier recognition of UM.",
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