Incidence of uveal melanoma surveillance and related outcomes in the immunotherapy era in a rural healthcare system.

Abstract

e21598 Background: Uveal melanoma has an incidence of 5 cases/million in the United States, with higher incidence among men and those of fairer complexions. Stage I patients have a 20% risk of recurrence to a distant site. Those who do recur tend to have poor outcomes, with median overall survival ranging from 3 to 30 months. This disease has no proven adjuvant therapy. After initial definitive treatment, surveillance alone is typically the most common recommendation, but guidance for surveillance imaging is lacking. We sought to determine the incidence of uveal melanoma surveillance along with associated health-related outcomes in these patients in our rural healthcare system. Methods: Following Institutional Review Board approval, we identified patients with uveal melanoma diagnoses treated with definitive therapy who had ≥3 months of follow-up between January 2010 and January 2023. Patients with metastatic disease at presentation were excluded. Via retrospective review of electronic health records, we captured demographics, disease, treatment, and recurrence specific variables. Appropriate analysis was completed in R version 4.4.3 with a significance level of 0.05. Results: Fifty-seven patients met inclusion criteria. Of these, 31 (54%) were men, 57 (100%) were White, and their median age at diagnosis was 62 years. Ten (18%) underwent enucleation for initial definitive treatment, 39 (68%) had plaque/radiation therapy, 2 (4%) had transpupillary thermal therapy, and 6 (11%) had unknown primary treatment. Following initial definitive treatment, 22 (39%) patients had routine surveillance visits, and 11 (19%) had routine imaging of the liver to screen for metastatic disease. Married patients were less likely than unmarried to participate in surveillance, while the remaining demographic variables were not significantly different. In total, 16 (28%) patients had recurrence. Of these, 9 (56%) had oligometastatic disease defined as 1 to 3 sites of metastasis, and 14 (88%) had at least 1 liver metastasis. Ten of the 16 (63%) received either checkpoint therapy or bispecific T-cell engager immunotherapy. Seven of the 16 (44%) participated in some form of surveillance. Overall survival of those who had surveillance imaging was not significantly different from those who did not. Conclusions: A minority of patients with definitively treated uveal melanoma participated in surveillance visits, and even fewer completed regular screening imaging. Recurrence rates reflected the national average and frequently involved the liver. No differences in survival rates were seen between patients who underwent surveillance (with or without imaging) and those who were not surveilled. This study was limited by small sample size at a single institution. More research is needed to assess the utility of uveal melanoma surveillance.