Abstract
Purpose :
The impact of primary tumor treatment on the survival of patients with uveal melanoma is uncertain and it is debated if a beneficial survival effect exists at all.
Methods :
PubMed, Web of Science and Embase were searched for articles published in any language and in any year. Publications were included if they reported patients with primary melanoma of the choroid or ciliary body with ≥ 5-year follow-up for patients without metastases. Studies were excluded if patients had received any kind of treatment for their primary tumor within 5 years from diagnosis. The long-term cumulative metastasis-free and overall survival of the included patients was estimated and contrasted to cohorts of treated tumors.
Results :
Seven studies with a total of 19 patients were included. Seven of the patients that initially refused treatment were eventually enucleated at a mean of 13 years after diagnosis (SD 10). Tumor size at diagnosis and last follow-up was available for eight patients. All of these were either small or medium-sized. Five tumors with specified diameter and/or thickness grew to a mean of 2.4 times its original size until last follow-up. The cumulative metastasis-free survival for 17 patients with choroidal or ciliary body melanoma was 71 % at five years (95 % CI 49-93 %), 29 % at 10 years (7-51 %), 18 % at 15 years (0-36 %) and 11 % at 30 years (0-27 %). This was significantly worse than the survival in comparison cohorts of both medium-sized (Log-rank p<0.001) and large treated tumors (Log-rank p<0.01).
Conclusions :
Patients that do not undergo treatment for their primary uveal melanoma are exceedingly rare in the literature. Of the published cases, eight or nine out of ten have eventually developed metastases. This indicates that primary tumor treatment may prevent metastases.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.