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Original Investigation
July 2, 2020

Evaluation of Racial, Ethnic, and Socioeconomic Associations With Treatment and Survival in Uveal Melanoma, 2004-2014

Author Affiliations
  • 1Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
JAMA Ophthalmol. Published online July 2, 2020. doi:10.1001/jamaophthalmol.2020.2254
Key Points

Question  Is race/ethnicity or lower socioeconomic status in patients with uveal melanoma associated with increased odds of primary enucleation or decreased survival?

Findings  This cohort study of 4475 patients with uveal melanoma from 2004 to 2014 found that patients who are nonwhite and socioeconomically disadvantaged are more likely to receive primary enucleation despite disease stage at presentation. There appear to be no racial, ethnic, or socioeconomic differences in disease-specific survival.

Meaning  The findings of this study suggest that racial, ethnic, and socioeconomic status disparities are present in uveal melanoma treatment and survival; further research is needed to elucidate the sources of these disparities.

Abstract

Importance  Identifying disparities in uveal melanoma (UM) treatment patterns and survival across racial, ethnic, and socioeconomic (SES) groups reveals possible inequities in ophthalmologic health care.

Objective  To examine the association of race, ethnicity, and SES with UM treatment and survival.

Design, Setting, and Participants  A retrospective cohort analysis of 28% of the US population using the Surveillance, Epidemiology, and End Results (SEER) 18 registries from January 1, 2004, to December 31, 2014, was conducted. Data analysis was performed from April to July 2018. SEER identified 4475 individuals using International Classification of Diseases for Oncology, Third Edition site and morphology codes.

Exposures  Race, ethnicity, and SES estimated by tertile using Yost Index composite scores.

Main Outcomes and Measures  Treatment odds ratios (ORs), 1-year and 5-year survival estimates, mortality hazard ratios (HRs), and Kaplan-Meier survival curves. Hypothesis was formulated before data collection.

Results  Multivariate analyses of 4475 individuals (2315 [51.7%] men; non-Hispanic white, 4130 [92.3%]; nonwhite, 345 [7.7%]) showed that patients who were nonwhite (OR, 1.45; 95% CI, 1.12-1.88) and socioeconomically disadvantaged (lower SES: OR, 2.21; 95% CI, 1.82-2.68; middle SES: OR, 1.86; 95% CI, 1.56-2.21) were more likely to receive primary enucleation. No interactions were observed between race/ethnicity, SES, and stage at diagnosis. From 2004 to 2014, rates of primary enucleation decreased across all racial/ethnic and SES groups, but disparities persisted. Socioeconomically disadvantaged patients had lower 5-year all-cause survival rates (lower SES: 69.2%; middle SES: 68.1%; and upper SES: 73.8%), although disease-specific survival did not vary significantly by racial/ethnic or SES strata. Mortality risk was associated with older age at diagnosis (56-68 years: HR, 1.70; 95% CI, 1.44-2.01; ≥69 years: HR, 3.32; 95% CI, 2.85-3.86), advanced stage of UM (stage 2: HR, 1.40; 95% CI, 1.19-1.65; stage 3: HR, 2.26; 95% CI, 1.87-2.73; and stage 4: HR, 10.09; 95% CI, 7.39-13.77), and treatment with primary enucleation (HR, 2.14; 95% CI, 1.88-2.44) with no racial/ethnic or SES variation.

Conclusions and Relevance  In this study, SEER data from 2004 to 2014 suggest that nonwhite and socioeconomically disadvantaged patients with UM are more likely to be treated with primary enucleation, although no such variation appears to exist in disease-specific survival. These differences reveal opportunities to address issues regarding treatment choice in UM.

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