Open Access Highly Accessed Research article

Bimodal mortality dynamics for uveal melanoma: a cue for metastasis development traits?

Romano Demicheli1*, Marco Fornili2 and Elia Biganzoli3

Author Affiliations

1 Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milano 20133, Italy

2 Medical Statistics and Biometry, Università di Milano, Milano 20133, Italy

3 Medical Statistics and Biometry, Università di Milano e Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milano 20133, Italy

For all author emails, please log on.

BMC Cancer 2014, 14:392  doi:10.1186/1471-2407-14-392

Published: 2 June 2014



The study estimates mortality dynamics (event-specific hazard rates over a follow-up time interval) for uveal melanoma.


Three thousands six hundred seventy two patients undergoing radical or conservative treatment for unilateral uveal melanoma, whose yearly follow-up data were reported in three published datasets, were analysed. Mortality dynamics was studied by estimating with the life-table method the discrete hazard rate for death. Smoothed curves were obtained by a Kernel-like smoothing procedure and a piecewise exponential regression model. The ratio deaths/patients at risk per year was the main outcome measure.


The three explored hazard rate curves display a common bimodal pattern, with a sudden increase peaking at about three years, followed by reduction until the sixth-seventh year and a second surge peaking at about nine years after treatment.


The bimodal pattern of mortality indicates that uveal melanoma metastatic development cannot be explained by a continuous growth model. Similar metastasis dynamics have been reported for other tumours, including early breast cancer, for which it supported a paradigm shift to an interrupted growth model, the implications of which are episodes of ‘tumour dormancy’. We propose that the concepts of tumour homeostasis, tumour dormancy and enhancement of metastasis growth related to primary tumour removal, convincingly explaining the clinical behaviour of breast cancer, may be used for uveal melanoma as well. To confirm this proposition, a careful analysis of uveal melanoma metastasis dynamics is strongly warranted.