Sex-based differences in early and late uveal melanoma-related mortality

Background: It is debated if there are sex-based differences in survival for patients with uveal melanoma. Previous observations of higher mortality for men in studies with < 10-year follow-up have not been replicated in studies with longer follow-up. It is therefore hypothesized that women have a worse survival in later periods. Methods: All patients diagnosed with primary uveal melanoma in Sweden between 1980 and 2017 were included (n = 2032). Survival differences between men and women in early (< 10 years from diagnosis) and late (>= 10 years) periods were analyzed. Results: At baseline, there were no significant differences in mean patient age, tumor thickness, diameter, ciliary body involvement, primary treatment modality, or in American Joint Committee on Cancer (AJCC) T-category between men and women. In total, 764 patients (425 women and 339 men) survived and were followed >= 10 years. In this group, men were significantly younger, but there were no differences in baseline tumor thickness, diameter, ciliary body involvement, primary treatment, or AJCC T-category. In competing risk analysis, women had higher incidence of uveal melanoma-related mortality in the late period (p = 0.036). In univariate Cox regression, male (HR 1.2, p = 0.049) and female sex (HR 1.8, p = 0.034) were significant predictors of uveal melanoma-related mortality in the early and late periods, respectively. Conclusion: Women with uveal melanoma have better survival in the first decade after diagnosis. Thereafter, female survivors are significantly older than men and have a higher incidence of uveal melanoma-related mortality.