Radiotherapy has a survival advantage over surgery in patients with choroidal melanoma: a retrospective cohort study of 6,871 patients

Yifan Wu ¹ Yulan Zhang ^2* Lu Shi ² Zhiqiang Ye ³ Yi Zhou ¹ Feiran Wang ¹

• ¹ Department of Ophthalmology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China, Nanchang, China
• ² Department of Ophthalmology, the Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, 330006, China, Nanchang, China
• ³ Department of General Practice, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China, Nanchang, China

Background: Choroidal melanoma is a rare yet aggressive ocular malignancy, accounting for approximately 85% of all ocular melanomas. This study aimed to investigate the association between treatment modalities and the risk of all-cause mortality and choroidal melanoma-specific mortality, thereby comparing the effects of different treatment modalities on patient prognosis. Methods: Data from patients diagnosed with choroidal melanoma between 2004 and 2021 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A total of 6,871 cases were included in the analysis. Univariate analysis, stratified analysis, and multiple regression analysis were performed to evaluate all-cause mortality and choroidal melanoma-specific mortality across different treatment modalities. Survival curves for the overall and stratified populations were generated using the Kaplan-Meier method. Choroidal melanoma-specific mortality was estimated using the competing risk regression method of Fine and Gray.In the fully adjusted model, the radiotherapy-only group exhibited a 45% reduction in all-cause mortality (HR = 0.55, 95% CI = 0.50-0.60, p < 0.0001) and a 54% reduction in choroidal melanoma-specific mortality (HR = 0.46, 95% CI = 0.41-0.52, p < 0.0001) compared to the surgery-only group. The radiotherapy group demonstrated superior long-term survival outcomes compared to other treatment modalities, with the highest 5-year overall survival (OS) rate of 0.7769 (95% CI = 0.7651-0.7889) and 10-year OS rate of 0.6203 (95% CI = 0.6038-0.6372).Additionally, the radiotherapy group achieved the highest 5-year choroidal melanoma-specific survival (CSS) rate of 0.8615 (95% CI = 0.8514-0.8717) and 10-year CSS rate of 0.7715 (95% CI = 0.7567-0.7866).Conclusions: Among patients diagnosed with choroidal melanoma, those who underwent radiotherapy alone exhibited significantly higher overall survival (OS) and choroidal melanoma-specific survival rates compared to those who received surgical intervention alone. However, for patients with advanced disease or evidence of metastatic spread, the individualization of treatment regimens remains critically important.