Findings recently published in Ophthalmology revealed the impact of uveal melanoma treatment timing and the risk of metastasis.
Give me some background first.
Uveal melanoma is the most common primary intraocular cancer found in adults. When looking at treatment, however, the impact of primary tumor treatment is murky—and a subject of debate, according to researchers—leading investigators to question the efficacy of uveal melanoma management.
While previous research did not identify a significant association between immediate treatment of medium-sized tumors and overall survival, a recent meta-analysis found that 88% of patients with small to medium-sized tumors who deferred treatment for over 5 years developed metastases during follow up.
Now, talk about the study.
Researchers investigated whether shorter delays of tumor treatment significantly impacts metastatic death (UM mortality) via a retrospective, single-center cohort design that examined the association between treatment timing of posterior uveal melanoma and metastatic death.
Who was included in the study?
Data of 1,145 patients diagnosed with posterior uveal melanoma from St. Erik Eye Hospital in Stockholm, Sweden, from 2012 to 2022 was collected.
Prompt treatment was defined as treatment administered within a month of diagnosis, while delayed treatment included cases where uveal melanoma was treated over a month after diagnosis.
Findings?
The average time between diagnosis and treatment was 34±56 days. Patients treated promptly had a greater largest basal tumor diameter (LBD) and tumor thickness.
Increased interval between diagnosis and treatment of posterior uveal melanoma was linked to a higher risk of UM mortality. This remained the case when data was adjusted for tumor diameter and thickness.
Tell me more.
Patients with delayed treatment had lower UM mortality in American Joint Committee on Cancer (AJCC) stage I for the first 10 years.
In AJCC stages II and III, delayed treatment was associated with greater UM mortality.
Expert opinion?
Greater time between the diagnosis and treatment of uveal melanoma was linked to an increased risk of metastatic death—emphasizing the importance of promptly treating tumors.
Anything else?
For every 10-day delay in treatment, the risk for UM mortality increased by 1%, further underlining the urgency of treatment.
Limitations?
The results may have been influenced by unaccounted variables because treatment timing was not randomized.
The accuracy of data regarding causes of death depended upon those responsible for filling out cause-of-death certificates, which cannot be verified.
Finally, it is possible that the risk factors may have been unevenly distributed amongst those included and excluded from the study.
Take home.
This study underlined the possible occurrence of late metastatic seeding and the urgency of treatment.
Per the study authors, these findings, “merit further validation in independent cohorts with longer follow-up and comprehensive tumor genetic data.”