Uveal metastasis: Clinical features and survival outcome of 2214 tumors in 1111 patients based on primary tumor origin

• Published in: Middle East African journal of ophthalmology Vol. 25; no. 2; pp. 81 - 90
• Main Authors: Shields, Carol, Welch, R, Malik, Kunal, Acaba-Berrocal, Luis, Selzer, Evan, Newman, Jennifer, Mayro, Eileen, Constantinescu, Alexandru, Spencer, Meredith, McGarrey, Mark, Knapp, Austen, Graf, Alexander, Altman, Alex, Considine, Sean, Shields, Jerry
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.04.2018; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Breast cancer; Cancer metastasis; Child; Choroid - pathology; Ciliary Body - pathology; Diagnostic Techniques, Ophthalmological; Female; Humans; Iris - pathology; Kidney cancer; Lung cancer; Male; Medical prognosis; Medical research; Medical screening; Melanoma; Metastasis; Middle Aged; Neoplasm Metastasis - diagnosis; Neoplasm Staging; Ophthalmology; Original; Pancreas; Patient outcomes; Patients; Pennsylvania - epidemiology; Prognosis; Prostate; Radiation therapy; Retrospective Studies; Survival Rate - trends; Thyroid gland; Tumors; Uveal Neoplasms - diagnosis; Uveal Neoplasms - mortality; Uveal Neoplasms - secondary; Young Adult; eye; Choroid; iris; uvea; ciliary body; metastasis
• ISSN: 0974-9233; 0975-1599; 0975-1599; 0974-9233
• DOI: 10.4103/meajo.MEAJO_6_18

PURPOSE: The purpose of this study is to evaluate patients with uveal metastasis based on primary tumor site. METHODS: Retrospective analysis from Wills Eye Hospital, Philadelphia, PA, USA, for uveal metastasis clinical features and outcomes based on the primary tumor site. RESULTS: There were 2214 uveal metastases diagnosed in 1111 consecutive patients. The demographics included mean age of 60 years (median 61 years), Caucasian race (88%), and female gender (64%). The tumor was unilateral (82%) and primary site was established before uveal metastasis (67%). The primary tumor originated in the breast (37%), lung (26%), kidney (4%), gastrointestinal (GI) tract (4%), cutaneous melanoma (2%), lung carcinoid (2%), prostate (2%), thyroid (1%), pancreas (1%), other sites (3%), and unknown (16%). Comparative analysis of the 5 most common primary sites (breast, lung, kidney, GI tract, and cutaneous melanoma), revealed metastasis at mean age (57, 62, 66, 61, 59 years), as unilateral tumor (74%, 86%, 85%, 93%, 85%), with mean number of metastasis/eye (1.9, 1.7, 1.0, 1.1, 2.0), and in females (99%, 46%, 26%, 25%, 30%). Choroidal metastases measured mean base (9.3, 10.2, 9.1, 11.0, 7.3 mm), mean thickness (2.4, 3.6, 4.4, 4.0, 2.9 mm), and demonstrated predominant color yellow (94%, 91%, 56%, 97%, 36%). Of the 769 patients with documented follow-up, mean patient survival was poor (22.2, 11.5, 8.6, 12.4, 11.4 months) and Kaplan-Meier analysis revealed 3-year survival (33%, 19%, 0%, 14%, 21%) and 5-year survival (24%, 13%, 0%, 14%, 21%). The worst survival was found in patients with pancreatic metastasis (mean 4.2 months) and best survival with lung carcinoid (92% at 5 years). CONCLUSION: In a tertiary referral service, uveal metastasis originates from cancer in the breast, lung, kidney, GI tract, cutaneous melanoma, or others. Overall prognosis is poor with 5-year survival at 23% and worst survival with pancreatic metastasis whereas best survival with lung carcinoid metastasis.