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Surgery vs. radiotherapy in patients with uveal melanoma

Analysis of the SEER database using propensity score matching and weighting

Chirurgie vs. Strahlentherapie bei Patienten mit Uveamelanom

Analyse der SEER-Datenbank mithilfe von Propensity-Score-Matching und -Gewichtung

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Abstract

Background

The treatment modalities for uveal melanoma (UM) include surgery and radiotherapy (RT). The utilization of RT as a strategy for organ preservation has been increasing, but the survival difference between the two aforementioned treatment modalities has not been reported.

Methods

An observational and cohort study was performed using a propensity score with an already existing public database. Patients diagnosed with UM within the period from 2004–2013 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. One-to-one matching and inverse probability of treatment weighting (IPTW) using the propensity score were used to estimate and compare survival rates.

Results

Overall, 3291 patients were treated: 2503 received RT only (RT group) and 788 received surgical resection only (surgery group). The RT group had an improved crude 5‑year overall survival (OS) rate compared with the surgery group (76% vs. 60%, P < 0.001), and an improved 5‑year melanoma-specific survival (MSS) rate (89% vs. 73%, P < 0.001). Compared to the surgery group, the RT group was associated with improved OS (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.38–0.73, P < 0.001) and MSS (HR 0.48, 95% CI 0.35–0.65, P < 0.001) in the matched cohort. The survival benefit of the RT group maintained after adjustment with IPTW, both in OS and MSS.

Conclusions

To our knowledge, the present study was the first to demonstrate the survival difference between the two treatment modalities for UM using both the propensity score matching and weighting methods with the SEER database. The current study suggests that RT may provide a survival advantage over surgery in the treatment of UM.

Zusammenfassung

Hintergrund

Die Behandlungsmodalitäten für das Uveamelanom (UM) sind die Chirurgie und Strahlentherapie (RT). Die Nutzung der RT als Strategie zum Organerhalt hat zugenommen, aber der Unterschied in der Überlebensrate zwischen den beiden zuvor genannten Behandlungsmodalitäten wurde nicht berichtet.

Methoden

Beobachtungs- und Kohortenstudie unter Verwendung eines Propensity-Scores mit einer bereits vorhandenen öffentlichen Datenbank. Patienten, bei denen im Zeitraum von 2004 bis 2013 ein UM diagnostiziert worden war, wurden aus der Datenbank Surveillance, Epidemiology, and End Results (SEER) ausgewählt. Eins-zu-eins-Matching und inverse Behandlungswahrscheinlichkeitsgewichtung (IPTW) unter Heranziehung des Propensity-Scores wurden angewendet, um die Überlebensraten abzuschätzen und zu vergleichen.

Ergebnisse

Insgesamt wurden 3291 Patienten behandelt: 2503 erhielten nur eine RT (RT-Gruppe) und 788 erhielten nur eine chirurgische Resektion (Chirurgiegruppe). Die RT-Gruppe hatte im Vergleich zur Chirurgiegruppe eine verbesserte 5‑Jahres-Gesamtüberlebensrate (OS; 76 % vs. 60 %, P < 0,001) und eine verbesserte melanomspezifische 5‑Jahres-Überlebensrate (MSS; 89 % vs. 73 %, P < 0,001). Im Vergleich zur Chirurgiegruppe war die RT-Gruppe mit einem verbesserten OS (Hazard Ratio [HR] 0,52, 95 %-Konfidenzintervall [KI] 0,38–0,73, P < 0,001 und MSS [HR 0,48, 95 %-KI 0,35–0,65, P < 0,001]) in der gematchten Kohorte assoziiert. Der Überlebensvorteil der RT-Gruppe blieb nach der Anpassung mit IPTW erhalten, sowohl im OS als auch im MSS.

Schlussfolgerungen

Nach unserer Kenntnis war die vorliegende Studie die erste, die den Überlebensunterschied zwischen den beiden Behandlungsmodalitäten für UM unter Verwendung sowohl des Propensity-Score-Matchings als auch der Gewichtungsmethoden mit der SEER-Datenbank demonstrierte. Die aktuelle Studie deutet darauf hin, dass die RT einen Überlebensvorteil gegenüber der Operation in der Behandlung von UM bieten kann.

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Authors and Affiliations

  1. Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea (Republic of)

    Bum-Sup Jang

  2. Department of Radiation Oncology, SMG-SNU Boramae Medical Center, 39 Boramae-Gil, Dongjak-gu, Seoul, Korea (Republic of)

    Ji Hyun Chang

  3. Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea (Republic of)

    Sohee Oh

  4. Department of Radiation Oncology, Kyunghee University Hospital, Seoul, Korea (Republic of)

    Yu Jin Lim

  5. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea (Republic of)

    Il Han Kim

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  1. Bum-Sup Jang
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  2. Ji Hyun Chang
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  4. Yu Jin Lim
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  5. Il Han Kim
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Corresponding author

Correspondence to Ji Hyun Chang.

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Conflict of interest

B.-S. Jang, J.H. Chang, S. Oh, Y.J. Lim and I.H. Kim declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Caption Electronic Supplementary Material

Supplementary Fig. 1 Trends in treatment over time

Supplementary Table 1 Standardized differences after propensity score matching and weighting

66_2017_1203_MOESM3_ESM.tif

Supplementary Fig. 2 Overall survival of radiotherapy vs. surgery classified by T stage in the matched cohort and in the weighted cohort

66_2017_1203_MOESM4_ESM.tif

Supplementary Fig. 3 Melanoma-specific survival of radiotherapy vs. surgery classified by stage in the matched cohort and weighted cohort

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Jang, BS., Chang, J.H., Oh, S. et al. Surgery vs. radiotherapy in patients with uveal melanoma. Strahlenther Onkol 193, 931–942 (2017). https://doi.org/10.1007/s00066-017-1203-0

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  • DOI: https://doi.org/10.1007/s00066-017-1203-0

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