| Abstract [eng] |
Background. Uveal melanoma is the most common primary intraocular tumor in adults and is associated with a high risk of metastasis. Its incidence in Lithuania is high, however, data on its characteristics in this country remain limited. Aim. To evaluate the associations between histopathological features of uveal melanoma and disease outcomes. Objectives. To assess demographic and clinical characteristics of the study population, determine histopathological features of the tumors, compare primary and secondary enucleation groups, and identify which histopathological characteristics are associated with disease outcomes. Methods. A retrospective cohort study was conducted, analysing data of patients treated at the Eye Disease Center of Vilnius University hospital Santaros Clinics between 2005 and 2024, who underwent enucleation for uveal melanoma. Data was processed using Microsoft Excel and R statistical software. Results. The study included 48 patients: 18 men and 30 women. The median age was 66,5 years at diagnosis and 70 years at enucleation. The most common tumor location was the choroid, with equal distribution between both eyes. Frequent complications included secondary glaucoma, amaurosis, and retinal detachment. Concomitant malignancies were diagnosed in 6 patients. 29 patients underwent primary enucleation and 19 – secondary, most commonly after brachytherapy. The median time from diagnosis to enucleation was 19,5 months. The main indication for enucleation was ocular pain. The mean tumor diameter was 14.92 millimetres, and median thickness 10 millimetres. Most tumors were classified as T2–T3. Spindle cell type was the most common (n = 22), followed by mixed (n = 13) and epithelioid (n = 12). Epithelioid tumors were associated with more advanced T categories. Mitotic activity was observed in 16 cases, scleral invasion in 15, necrosis in 7, and vascular invasion in 6. Metastases were detected in 16 patients, most commonly in the liver. Higher T category was associated with increased metastasis risk (p = 0.048), whereas histopathological type was not (p = 0.925). The median time from enucleation to metastasis was 12.5 months. Metastasis-free survival showed borderline significance between T categories (p = 0.05). Mortality was related to age at diagnosis (p = 0.025) and the development of metastases (p = 0.004). The median time from enucleation to death was 20.5 months. Overall survival was significantly associated with T category (p = 0.03), but not with histopathological type (p = 0.2). Conclusions. Women made up the majority of the study population. The median age at diagnosis was 66,5 years. Choroidal melanoma was the most common, and the most frequent complications were secondary glaucoma, amaurosis, and retinal detachment. Most tumors were classified as T2–T3, with spindle cell type predominating. Other frequent histopathological characteristics were mitotic activity and scleral invasion. The most common indication for enucleation was ocular pain. Primary enucleation was more common than secondary and was associated with larger tumor size and shorter time from diagnosis to enucleation and from enucleation to death. Metastases occurred in one third of patients, most frequently in the liver. Higher tumor T category was associated with increased metastasis risk and worse overall survival, with a borderline association with shorter metastasis-free survival. Histopathological tumor type was not significantly related to disease outcomes. |
