Affiliation:
1. Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet , Stockholm, Sweden
2. Ocular Oncology Service and St. Erik Ophthalmic Pathology Laboratory, St. Erik Eye Hospital , Stockholm, Sweden
Abstract
Abstract
Background
Uveal melanoma has a high propensity for metastatic spread. Yet, the comprehensive causes of death in a large consecutive cohort followed from diagnosis to death remain unknown.
Methods
All Swedish patients diagnosed with melanoma involving the iris, choroid, and/or ciliary body after January 1, 1960, were assessed for this study. Sequential inclusion was halted upon encountering the first surviving patient during data collection. Causes of death were collected from the National Cause of Death Registry and audited by analysis of up to 15 causative diagnoses.
Results
A total of 1530 patients were included, each histopathologically verified with primary uveal melanoma. Mortality from metastatic uveal melanoma was 31% at 5 years, 40% at 10 years, 45% at 20 years, 47% at 30 years, and 48% between 40 and 60 years post-diagnosis. Notably, the longest period between diagnosis and metastatic fatality was 49.6 years. Additionally, 186 other causes of death were recorded, with cardiovascular diseases constituting 26%, other cancers 10%, stroke 6%, dementias 2%, and lower respiratory infections 2% of total mortalities. Mortality from colorectal, lung, prostate, and stomach carcinomas over 60 years were 1.4%, 1.4%, 1.2%, and 0.9%, with metastatic uveal melanoma being the leading cumulative and annual cause of death for the initial 41 and 5 years post-diagnosis, respectively.
Conclusions
In this large consecutive cohort, half of the included patients ultimately succumbed to metastatic uveal melanoma, with deaths occurring up to 50 years after diagnosis. One-quarter and one-tenth of patients died from cardiovascular diseases and other cancers, respectively.
Funder
Swedish Society of Medicine
Swedish Eye Foundation
Region Stockholm
Swedish Cancer Society
Crown Princess Margareta Foundation for the Visually Impaired
Carmen and Bertil Regnér Foundation
Publisher
Oxford University Press (OUP)