A comparison of cause-specific melanoma mortality and all-cause mortality in survival analyses after radiation treatment for uveal melanoma.
OBJECTIVE
To determine the causes and patterns of mortality after uveal melanoma radiation.


METHODS
A cohort study from a single institution was performed. Mortality was modeled using semiparametric survival techniques. All cause and cause-specific mortality analyses were performed. Mortality was compared with expected mortality from the U.S. census data.


METHODS
A total of 731 patients were studied, and 710 (97%) of these had medium or large melanomas. The mean tumor diameter was 11.3 mm, and the mean tumor thickness was 5.8 mm. Ciliary body was involved in 122 (17%) of patients. Complete follow-up was available on 99.6% (728 of 731) of patients.


METHODS
The authors analyzed the distribution and causes of post-treatment mortality.


RESULTS
The 5- and 10-year all-cause Kaplan-Meier survival rates were 75.6% and 62.3%, respectively. Both melanoma risk factors (older age, ciliary body involvement, and larger tumor diameter) and nonmelanoma risk factors (older age and medical condition) were significant prognostic factors of all-cause mortality. Deaths from nonmelanoma causes accounted for 91 (42.3%) of 215 deaths. The 5-year and 10-year estimates of nonmelanoma deaths were 8.3% and 15.9%, respectively. Nonmelanoma mortality was similar to that observed in the general U.S. population (91 observed, 98.1 expected). Melanoma metastases accounted for 124 (57.7%) of 215 deaths. The 5- and 10-year estimates for probability of metastatic death were 16.1% and 21.8%, respectively. The largest tumor diameter was the best predictor for melanoma mortality; ciliary body involvement, older age, and distance from the fovea also were significant in multivariate analyses.


CONCLUSIONS
A significant proportion of patients with uveal melanoma die of nonmelanoma causes after radiation. In analyzing prognostic factors, considerable information may be lost if analyses are based on all-cause mortality rather than cause-specific mortality.
Kroll
S
S
Department of Ophthalmology, University of California, San Francisco 94143, USA.
Char
D H
DH
Quivey
J
J
Castro
J
J
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D015984:Causality; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011882:Radiotherapy, High-Energy; D012495:San Francisco / Q000453:epidemiology; D015996:Survival Rate; D014604:Uveal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy