Trends in mortality, incidence, and survival of uveal melanoma: A SEER-based retrospective analysis.

Abstract

e21581 Background: Uveal melanoma (UM) is the most prevalent primary intraocular malignancy in the adults. The age-adjusted incidence of UM in the US is 4.6-5.2 cases per million. UM typically develops de novo and has a distinct tendency to metastasize to the liver. Clinical manifestations of UM range from asymptomatic to visual disturbances like flashes, floaters, or field defects. This study examines mortality trends and survival factors in UM patients over the past two decades. Methods: We extracted UM cases using ICD codes 8720/3 (malignant melanoma), C69.3 (choroid), and C69.4 (ciliary body) from the SEER Research Plus Data (17 Registries, Nov 2023, 2000-2021). Data were stratified by age, gender, race, primary site, laterality, stage, and treatment type. Results were analysed using the Log-Rank test (GraphPad Prism). Results: A total of 7,840 UM cases (2000-2021) were analyzed, with 51.4% males and 48.6% females. The median age at diagnosis was 63 years, and 89.7% of cases originated in the choroid. UM was most common in Caucasians (91.25%), followed by Hispanics (5.6%), Asian/Pacific Islanders (1.34%), unknown race (0.88%), Black (0.64%), and American Indian/Alaska Natives (0.27%). The 5-year Mortality-to-Incidence Ratio (MIR) declined significantly over time: 63.5% (2000-2005), 51.6% (2006-2010), 35.6% (2011-2015), and 13.6% (2016-2021) (p = 0.0293). The median overall survival (mOS) was 154 months, with a 1-year survival of 0.962 (CI 95%, 0.957-0.966), 3-year survival of 0.844 (CI 95%, 0.835-0.852), and 5-year survival of 0.745 (CI 95%, 0.734-0.755). mOS was significantly associated with Age (31-60 years, 255 months; 60+ years, 101 months; p < 0.0001), Gender (females, 164 months; males, 144 months; p = 0.0009), Race (Hispanics, 195 months; Black, 193 months; White, 151 months; p = 0.0038), Primary site (choroid, 156 months; ciliary body, 145 months; p = 0.006), Laterality (right, 158 months; left, 152 months; unknown/bilateral, 47 months; p < 0.0001), and Stage (localized, 170 months; regional, 87 months; distant, 13 months; p < 0.0001). Survival analysis by treatment type revealed significant differences: XRT (170 months) vs no XRT (89 months, p < 0.0001), chemotherapy (66 months) vs no chemotherapy (157 months, p < 0.0001), and surgery (91 months) vs no surgery (171 months, p < 0.0001). Conclusions: UM primarily affects Caucasians, originates in the choroid, and shows a slight male predominance. Our analysis shows a decline in the 5-year MIR from 2000 to 2021, likely due to advances in localized, liver-directed, and systemic therapies. Better survival outcomes were linked to younger age, female sex, Black or Hispanic race, choroidal origin, unilateral localized disease, and XRT. Lower survival outcomes with chemotherapy and surgery may result from their use in patients with higher tumor burden, with or without metastasis, potentially impacting overall survival in this cohort.