Childbearing history associated with improved survival in choroidal melanoma

Background: Research in cutaneous melanoma suggests that women may experien ce better tumor-dependent survival than men, and some studies have shown th at the advantage is specific to childbearing. Objective: To examine whether childbearing may be a favorable prognostic fa ctor 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 we re documented in follow-up. Results: Overall multivariate-adjusted death rates from metastasis were app roximately 25% higher in nulliparous women (relative risk [RR], 1.23; 95% c onfidence interval [CI], 0.83-1.82) and men (RR, 1.25; 95% CI, 1.00-1.56) t han in women who had given birth. The protective influence of parity was st rongest 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 16 months of follow-up). The level of p rotection 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.