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

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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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Authors and Affiliations

  1. Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Glenda M. Delgado-Ramos, Ari VanderWalde & Arnel M. Pallera

  2. Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Fridtjof Thomas

  3. Division of Hematology and Oncology, West Cancer Center, 7945 Wolf River Boulevard, Germantown, Memphis, TN, 38138, USA

    Ari VanderWalde & Arnel M. Pallera

  4. Department of Ophthalmology, University of Tennessee Health Science Center - Hamilton Eye Institute, Memphis, TN, USA

    Benjamin King & Matthew Wilson

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  1. Glenda M. Delgado-Ramos
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Correspondence to Arnel M. Pallera.

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Delgado-Ramos, G.M., Thomas, F., VanderWalde, A. et al. Risk factors, clinical outcomes, and natural history of uveal melanoma: a single-institution analysis. Med Oncol 36, 17 (2019). https://doi.org/10.1007/s12032-018-1230-4

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  • DOI: https://doi.org/10.1007/s12032-018-1230-4

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