Prolonged survival after complete resection of metastases from intraocular melanoma

• Published in: Cancer 2004-01, Vol.100 (1), p.122-129
• Main Authors: Hsueh, Eddy C., Essner, Richard, Foshag, Leland J., Ye, Xing, Wang, He‐Jing, Morton, Donald L.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; complete resection; Dermatology; Eye Neoplasms - pathology; Female; Follow-Up Studies; Humans; intraocular melanoma; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medical sciences; Melanoma - secondary; Melanoma - surgery; metastases; Middle Aged; Prognosis; prolonged survival; Retrospective Studies; Survival Analysis; Tumors; Tumors of the skin and soft tissue. Premalignant lesions
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.11872

BACKGROUND The median survival time is only 2–6 months after a diagnosis of metastases from intraocular melanoma. Because complete resection of metastatic melanoma from a cutaneous primary tumor can prolong survival, the authors hypothesized that resection also might benefit patients with metastases from an intraocular site. METHODS From 1971 to 1999, 112 patients with metastatic melanoma from an intraocular site were enrolled in various treatment protocols after informed consent was obtained. Prospectively recorded clinical variables and follow‐up information were retrieved from the patient database. Survival curves were estimated using the Kaplan–Meier method. Univariate analysis was performed with the log‐rank test. Multivariate analysis was performed using the Cox proportional hazards regression model. Propensity score analysis was used to reduce the imbalance between subgroups and to assess treatment effect. RESULTS Seventy‐eight patients (70%) presented with liver involvement. Twenty‐four patients (21%) underwent resection of metastatic lesions. At a median follow‐up time of 11 months (range, 1–97 months; > 36 months for survivors), the median survival period was 11 months and the 5‐year survival rate was 7%. Univariate analysis showed that surgical resection, site of metastases, number of metastatic lesions, and disease‐free interval were correlated significantly with survival (P < 0.001, P < 0.001, P < 0.001, and P = 0.031, respectively). Multivariate analysis showed that surgical resection was significant (P = 0.008) but that the site of metastases was not (P = 0.146). The median survival and the 5‐year survival rate were 38 months and 39%, respectively, for surgical patients, versus 9 months and 0%, respectively, for nonsurgical patients. After adjusting for covariate imbalance by propensity score analysis, surgery remained significant (P = 0.021) on multivariate analysis. CONCLUSIONS Complete resection may prolong survival in certain patients with distant metastases from intraocular primary melanoma. However, the overall unfavorable prognosis indicates an urgent need for more effective nonsurgical interventions. Cancer 2004;100:122–9. © 2003 American Cancer Society. Surgery may prolong the survival of selected patients with metastatic intraocular melanoma, but effective systemic treatment is urgently needed for this disease.