Survival outcomes and prognosis predictors of uveal melanoma from Indian population

Dear Editor, I read with keen interest the recent article titled “Survival outcomes and prognosis predictors of uveal melanoma from Indian population” by Shah P, et al.,[1] which provides a valuable assessment of choroidal and ciliochoroidal melanoma outcomes in an Indian tertiary care setting. This study is particularly relevant, considering the paucity of survival data for uveal melanoma (UM) in Asian Indian populations and the distinctive demographic and clinical attributes compared to Western cohorts. The authors’ retrospective analysis of 150 patients—almost half being ≤50 years at presentation—extends our understanding of UM within younger populations, a demographic trend less seen in Western literature.[1] The reported rates of melanoma metastasis-related mortality (16%) and the corresponding 5-year disease-specific survival (DSS) of 84% (95% CI: 77–90%), declining to 66% (95% CI: 53–77%) at 10 years, are notable and reflect favorable survival compared to some international studies, which often indicate a 50% metastasis rate and 5-year mortality rates up to 31%.[2,3] Prognostic Predictors and Their Implications The study confirms that tumor stage, particularly higher American Joint Committee on Cancer (AJCC) T stage, is a strong independent predictor of both metastasis and mortality, consistent with established literature.[1,3] The reported hazard ratios—1.78 for T2, 4.24 for T3, and 6.38 for T4 versus T1—strongly underscore the increasing risk with advanced disease stage. Age at presentation, tumor size, ciliary body involvement, and cell morphology are long-known prognosticators in UM. Existing evidence indicates that older age, larger diameter, ciliary body location, and epithelioid cell dominance independently portend a poorer prognosis.[3,4] The current study observed a relatively younger mean age, and it would be instructive to see survival stratified by age bands and cell type, which could clarify whether Indian younger patients have genuinely more indolent disease or if there are biological differences.[1,3,4] Comparisons with Global Data While Western studies commonly report a 5-year mortality nearing 50% in all-comers with UM and a high rate of metastases, particularly to the liver, the Indian cohort demonstrates both longer survival and lower overall mortality.[3,4] This could reflect differences in genetic background, tumor biology, the high prevalence of early-stage detection, or perhaps differences in access to and modalities of treatment. Notably, the window of greatest metastatic risk remains within the first 5 years after diagnosis—a finding remarkably consistent with global UM literature. This observation justifies the authors’ recommendation for structured follow-up, focused intensively in the initial 5 years.[1,5] The critical need for early detection of metastases—especially hepatic—demands a standardized, practical, and resource-sensitive surveillance protocol. Study Strengths and Limitations The authors should be lauded for comprehensive follow-up, leveraging modern communication for survival tracking. However, the retrospective nature and single-center design could introduce patient selection bias. It would also be beneficial for future studies to integrate molecular and cytogenetic prognosticators (e.g., BAP1 status, chromosome 3 loss, PRAME expression), now recognized as pivotal in UM prognostication and management.[3,6] Furthermore, identification of specific causes of mortality and longitudinal quality of life outcomes could be included in subsequent work to provide a holistic view. Additionally, gaps remain regarding the impact of therapeutic modalities on survival and metastasis (i.e., enucleation vs. plaque brachytherapy vs. proton beam), which are key considerations in contemporary management. Conclusions and Recommendations This report is a significant addition to the sparse Indian and global data on uveal melanoma and reinforces the crucial role of local staging, meticulous surveillance, and early intervention in optimizing patient outcomes. I encourage the authors and the Indian ocular oncology community to further explore genetic, environmental, and healthcare access factors that may underlie the observed survival advantage, along with deeper analysis incorporating contemporary molecular prognosticators and treatment modalities. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.