Secondary primary malignancies, cancer-specific survival, and disparities in enucleation: An overview of ocular melanoma from Surveillance, Epidemiology, and End Results (SEER) data (2000-2021).

Abstract

e23354 Background: Ocular melanoma (OM) is a rare, aggressive malignancy, accounting for most primary intraocular tumors in adults over 50 years of age. Significant disparities persist in outcomes despite advancements in diagnosis and treatment. We studied the trends in incidence, cancer-specific survival (CSS), enucleation disparities, and the burden of secondary primary malignancies (SPM) using SEER data from 2000 to 2021. Methods: Patients ≥ 50 years with OM were included. SEER*Stat & Jamovi 2.3.28 were used for analysis. Incidence rates were assessed using annual percent change (APC). CSS was evaluated at 6 months, 12 months, and 5 years by sex, race, and ethnicity. Enucleation rates were analyzed by sex, race, income group, and origin, with statistical comparisons performed using chi-squared tests. The risk of SPMs was assessed using observed to expected (O/E) ratios, confidence intervals (CI), and excess risks per 10,000 person-years. Results: The age-adjusted OM incidence declined with APC of -0796% (95% CI: -1.18 to -0.41; p < 0.001). CSS at 5 years was 89.6% (95% CI: 89.0–90.2%). Hispanic and non-White patients demonstrated poorer CSS vs. Non-Hispanic White patients, with the latter showing the highest 6-month CSS of 98.6% (95% CI: 98.4–98.8%). Significant disparities were observed in enucleation rates. Males had a higher rate of enucleation (17.0%) compared to females (14.5%; p < 0.001). Patients with Unknown (24.3%) and Black race (22.4%) exhibited the highest enucleation rate, while White patients had the lowest rate at 15.7% (p = 0.021). Low-income patients had a higher enucleation rate (20.6%) compared to medium- and high-income groups, both at approximately 11.1% (p < 0.001). The risk of SPMs was significantly elevated, with an overall O/E ratio of 6.48 (95% CI: 6.23–6.75). The most common SPMs were cancers of the liver (O/E: 11.5; 95% CI: 9.0–14.3), lung and bronchus (O/E: 7.8; 95% CI: 6.5–9.4), and pancreas (O/E: 5.6; 95% CI: 4.5–7.0). Conclusions: While the incidence of OM has declined and survival has improved, disparities in CSS, enucleation rates, and SPM risk persist across demographic groups. With radiation therapy being the mainstay of treatment given similar outcomes, rates of enucleation have declined over the years. Still, black, low-income, and male patients continue to face a disproportionate burden, highlighting the need for targeted intervention. We also noted a high rate of SPM in patients with OM. With increasing overall survival the burden of SPM is expected to increase and warrants the need for surveillance in this population.