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Childbearing history associated with improved survival in choroidal melanoma
K M Egan1, J L Quinn, E S Gragoudas
1Massachusetts Eye and Ear Infirmary, Department of Epidemiology, Harvard School of Public Health, Boston 02114-3096, USA. Kathleen.Egan@channing.harvard.edu
Background:
Research in cutaneous melanoma suggests that women may experience better tumor-dependent survival than men, and some studies have shown that the advantage is specific to childbearing.
Objective:
To examine whether childbearing may be a favorable prognostic factor in melanoma of the uveal tract.
Design:
Prospective follow-up study.
Setting:
Hospital.
Main Outcome Measure:
Death from metastatic choroidal melanoma.
Methods:
We evaluated a consecutive series of 1818 patients with choroidal melanoma, 748 parous and 165 nulliparous women and 905 men, after treatment with proton irradiation. Three hundred fifty-two deaths from metastasis were documented in follow-up.
Results:
Overall multivariate-adjusted death rates from metastasis were approximately 25% higher in nulliparous women (relative risk [RR], 1.23; 95% confidence interval [CI], 0.83-1.82) and men (RR, 1.25; 95% CI, 1.00-1.56) than in women who had given birth. The protective influence of parity was strongest in the early period following diagnosis and treatment (RR, 1.58; 95% CI, 0.88-2.86, and RR, 1.51; 95% CI, 1.04-2.19, in nulliparous women and men, respectively, during the first 36 months of follow-up). The level of protection increased with the number of live births (P for trend, .04).
Conclusion:
These data provide support for the hypothesis that a history of childbearing confers protection from death in choroidal melanoma.