Mortality after deferral of treatment or no treatment for choroidal melanoma

Bradley R Straatsma; Marie Diener-West; Robert Caldwell; Robert E Engstrom; Collaborative Ocular Melanoma Study Group

doi:10.4103/ijo.IJO_1499_18

Back

Mortality after deferral of treatment or no treatment for choroidal melanoma

Journal article

Open access

Peer reviewed

Mortality after deferral of treatment or no treatment for choroidal melanoma

Bradley R Straatsma, Marie Diener-West, Robert Caldwell, Robert E Engstrom and Collaborative Ocular Melanoma Study Group

Indian journal of ophthalmology, Vol.66(10), pp.1395-1400

10/2018

DOI: 10.4103/ijo.IJO_1499_18

PMCID: PMC6173014

PMID: 30249822

Files and links (1)

url

https://doi.org/10.4103/ijo.IJO_1499_18View

Published (Version of record) Open Access

Abstract

To report mortality of patients who were eligible for enrollment in the Collaborative Ocular Melanoma Study (COMS) clinical trials of medium-sized choroidal melanoma or large-sized choroidal melanoma but chose to defer treatment or receive no melanoma treatment. Prospective nonrandomized multicenter cohort study as an adjunct to COMS randomized clinical trials. Patient follow-up procedures included examinations, correspondence, telephone contacts, and National Death Index searches. Primary outcome was patient death measured by all-cause mortality. Secondary outcomes were melanoma treatment and melanoma metastasis. Of 77 patients eligible for COMS clinical trials who chose to defer or receive no melanoma treatment, 61 were appropriate candidates and 45 (74%) enrolled in the natural history study (NHS). In all, 42 patients (42 eyes) had medium melanoma, and the median follow-up was 5.3 years (range, 4-10.7 years). In all, 22 patients (52%) had subsequent melanoma treatment, and 20 (48%) had no melanoma treatment. For the 42 patients, Kaplan-Meier estimate of 5-year mortality was approximately 30% [95% confidence interval (CI), 18%-47%]. For COMS medium melanoma trial, 5-year mortality was 18% (95% CI, 16%-20%), not statistically significantly different from the NHS patients. After adjusting for differences in age and longest basal diameter, the 5-year risk of death for NHS patients versus COMS trial patients was 1.54 (95% CI, 0.93-2.56). Three patients had large melanoma. Melanoma metastasis was confirmed or suspected in 8 (42%) of 19 deaths. Greater mortality and higher risk of death for NHS patients are probative but not conclusive evidence of a beneficial, life-extending effect of medium melanoma treatment.

mortality

melanoma

Choroidal melanoma

COMS

uveal melanoma

Details

Title: Subtitle: Mortality after deferral of treatment or no treatment for choroidal melanoma
Creators: Bradley R Straatsma - Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
Marie Diener-West - Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MA, USA
Robert Caldwell - University of California, Los Angeles
Robert E Engstrom - Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
Collaborative Ocular Melanoma Study Group
Contributors: H Culver Boldt (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Resource Type: Journal article
Publication Details: Indian journal of ophthalmology, Vol.66(10), pp.1395-1400
DOI: 10.4103/ijo.IJO_1499_18
PMID: 30249822
PMCID: PMC6173014
NLM abbreviation: Indian J Ophthalmol
ISSN: 0301-4738
eISSN: 1998-3689
Language: English
Date published: 10/2018
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9984083236202771

Metrics

30 Record Views

18 Times Cited - Web of Science