Waiting to treat eye cancer costs lives, study confirms

An earlier study suggested that longer intervals between diagnosis and treatment of uveal melanoma are associated with worse prognosis. We evaluated whether a similar association could be observed in an independent cohort. Retrospective cohort of 336 patients with posterior uveal melanoma treated at a single referral center (2000–2011), assembled by investigators independent of the original report. We compared disease-specific (DSS) and overall survival (OS) across prespecified diagnosis-to-treatment intervals (≤ 15, 30, 45 days) using cumulative-incidence (Gray’s) and Kaplan–Meier analyses (unmatched and propensity-matched). Fine–Gray regression with treatment day as time zero estimated the subdistribution hazard ratio per 10-day delay. Tumor size and stage at diagnosis did not differ between patients treated within 30 days (prompt) and those treated after 30 days (delayed). In competing-risk analysis, delayed treatment was associated with a higher cumulative incidence of metastatic death. Kaplan–Meier OS—but not DSS—differed significantly between prompt and delayed treatment. A model of exponential tumor growth indicated that deferring treatment of a lesion of a medium-sized tumor by one month is associated with an estimated absolute increase in the 10-year competing-risk incidence of metastatic death by ≈ 0.8%. While treatment delay is unlikely to be among the strongest prognostic factors in uveal melanoma, this independent validation cohort supports an association between diagnosis-to-treatment intervals beyond about one month and worse survival.