Prognostic study of malignant melanoma of the uvea treated by enucleation

: In order to evaluate the clinical and histopathologic prognosis indicators of uveal melanomas treated with enucleation, 59 patients, followed up during 1 to 18 years were included in a retrospective study. Kaplan Meier survival curves were constructed and compared using the log rank test. The overall 5 and 10 years probabilities of survival were 74.9% and 48.5% respectively. Metastases were, or might have been, responsible for death in 83.3% of the cases. The median survival was 4 years 9 months (range less than 1 to 11 years). Fifty five per cent of the metastases occurred within 4 years of the enucleation and 90% within 8 years. For the patients with spindle cell melanomas, the 5 year probability of survival was 90% against 38% for the patients with epithelioid cell tumors. The median time to tumor related death was 5 years for the first group against 3 years 8 months for the second. The analysis of our data demonstrated the tumor volume to be a statistically significant clinical prognosis indicator. The following histopathologic parameters were also statistically significant prognosis indicators: the cell type (p less than or equal to 0.001), the mitotic activity, the state of the sclera, the presence of blood lakes. Statistical adjustments and determination of the instantaneous relative risk of death showed the histopathologic factors, specially the cell type, to be the most important indicators.