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  • Uveal Melanoma: Disparities in Treatment and Survival

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, August 2020

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    Rajeshuni et al. studied treatment and survival patterns of patients with uveal melanoma to determine if there are inequities by race, ethnicity, or socio­economic status. They found that non-White and socioeconomically disad­vantaged patients are more likely than others to receive primary enucleation, regardless of disease stage at presenta­tion. They found no meaningful differ­ences in disease-specific survival rates.

    For this retrospective analysis, the authors turned to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) 18 database. Data from these 18 SEER registries represented 28% of the U.S. population between 2004 and 2014.

    Socioeconomic status was estimated by tertile according to the Yost Index composite score, which includes many related variables. Because uveal mela­noma is uncommon in the non-White population, non-White and Hispanic patients were combined into one group for comparison with non-Hispanic Whites. Main outcome measures were treatment odds ratios (ORs), survival rates at years 1 and 5, mortality hazard ratios (HRs), and Kaplan-Meier survival curves.

    Altogether, 4,475 individuals with uveal melanoma were identified (52% male). Non-Hispanic Whites repre­sented 92% of the study population. Multivariate analyses showed that non-White patients (OR, 1.45) and socioeconomically disadvantaged patients (lowest status OR, 2.21; middle status OR, 1.86) were more likely than others to undergo enucleation.

    Although the rates of primary enu­cleation decreased for all racial/ethnic and socioeconomic groups from 2004 to 2014, disparities persisted. Socioeco­nomically disadvantaged patients had lower five-year all-cause survival rates (lowest status, 69.2%; middle status, 68.1%; upper status, 73.8%). There were no significant differences in dis­ease-specific survival rates according to race, ethnicity, or socioeconomic status. Mortality risk was linked to older age at diagnosis (1.70 HR for age 56-68 years; 3.32 HR for age ≥69 years) and higher disease stage (1.40, 2.26, and 10.09 HRs for stages 2, 3, and 4, respectively), as well as treatment with primary enucle­ation (2.14 HR).

    These findings suggest the need to understand why treatment inequi­ties have persisted, said the authors, particularly as globe-sparing therapies are now widely available. They noted that more research may “elucidate the potential role that clinicians and vari­ation in practice patterns play in these disparities.” (Also see related commen­tary by Jasmine H. Francis, MD, in the same issue.)

    The original article can be found here.