An evaluation of the influence of reproductive factors on the risk of metastases from uveal melanoma

Abstract

Background: There is a paucity of data concerning the possible role played by hormonal factors in the risk of metastases from intraocular melanomas.

Methods: The authors studied the influence of post-diagnosis pregnancy and oral contraceptive use in a group of women of reproductive age (45 or younger) who were treated for uveal melanoma by proton beam irradiation. A baseline reproductive history had been collected before irradiation for all women, and interim reproductive data were collected by mailed questionnaire.

Results: In this age group, the overall rate of metastasis among women was similar to that of men treated during the same interval (adjusted rate ratio: 1.28; 95% confidence interval: 0.62-2.67). A total of 24 full-term pregnancies were reported among the 139 women still menstruating at diagnosis. Twenty-three women reported regular oral contraceptive use. Metastases developed in 15 of the 139 women. Compared with other women in the series, rates of metastases were not higher among the women who reported pregnancies (P = 0.932) or oral contraceptive use (P = 0.424) after diagnosis.

Conclusion: Although based on limited numbers, results suggest that the hormonal environment has no appreciable influence on risk of metastases in younger women with uveal melanoma.

PIP: The rarity of uveal melanoma (150 cases diagnosed per year in the US) has impeded evaluation of the influence of hormonal factors such as pregnancy and oral contraceptive (OC) use on the risk of metastases. This concern was addressed in a study of the 139 women 45 years of age or younger who were treated for melanomas of the choroid or ciliary body by proton beam irradiation during July 1975-May 1991 at a Boston, Massachusetts, laboratory. A separate analysis compared the experiences of 121 men and 129 women under 45 years of age who received the same treatment at another facility. Metastases had developed in 15 of the 139 women by the close of the study. A total of 19 women had 24 full-term pregnancies in the 17 months preceding diagnosis or in the follow-up period (mean, 5.6 years). There was no significant difference between the five-year metastasis-free survival rates for pregnant and nonpregnant women (89% and 90%, respectively). 23 women used OCs after diagnosis. Again, the five-year metastasis-free rates were similar: 93% for OC users and 91% for nonusers. The second analysis failed to reveal sex differences in rates of metastases. Metastasis-free survival seven years after diagnosis was 85% in both women and men. Although these findings suggest that hormonal factors do not increase the risk of metastases from uveal melanoma, they must be regarded as tentative due to the small number of cases.