Uveal melanoma: Treatment approaches and prognostic outcomes based on the American joint committee on cancer staging

Abstract

Purpose To evaluate the clinical characteristics, treatment outcomes, and prognosis of uveal melanoma (UM) based on the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. Design Retrospective study. Methods Data on the clinical presentation, diagnostic methods, treatment approaches, and long-term outcomes of patients diagnosed with UM at a tertiary referral center in Thailand between 2010 and 2024 were included and analyzed. Results Of 106 patients included, the mean (range) age at diagnosis was 51.6 (16−86) years. The most common tumor location was the choroid (n = 100, 94.3%), followed by the ciliary body (n = 4, 3.8%) and iris (n = 2, 1.9%). AJCC tumor staging was T1 in 18.9%, T2 in 17.9%, T3 in 48.1%, and T4 in 15.1% of cases. Primary treatment included enucleation (n = 57, 53.8%), Ruthenium-106 (¹⁰⁶Ru) brachytherapy (n = 31, 29.2%), endoresection combined with ¹⁰⁶ Ru brachytherapy (n = 17, 16.0%), and exoresection (n = 1, 0.9%). At a median follow-up of 37.3 months, the overall globe salvage rate was 44.3%. Kaplan-Meier analysis showed a 5-year and 10-year distant metastasis rate of 22%, with disease-specific survival rates of 82% and 75%, respectively. The incidence of melanoma-related death was 3.4 per 100 person-years, increasing with tumor stage. In multivariate analysis, distant metastasis was the only significant factor associated with the overall survival outcome. Conclusions This study provides insights into the clinical features, treatment outcomes, and prognostic factors of UM in a Southeast Asian cohort. Tumor stage and the presence of metastasis significantly influence prognosis, highlighting the importance of early detection and individualized treatment strategies to improve patient outcomes.