According to federal statistics, mass shootings have tripled in the United States in the past decade. 1 These mass-casualty events can easily overwhelm the resources of local hospitals.
In US trauma centers, firearms are the second leading cause of trauma-related death in pediatric patients. 1 In children (<18 years), firearms are associated with one of the highest case fatality rates (16.7%) of all injur y mechanisms. 2 A c c o r d i n g t o t h e G u n Violence Archive, in 2019 alone, 3774 children experienced gun violence, including 985 killed and 2789 injured. 3 The US Centers for Disease Control and Prevention reports multiple-victim school homicide rates have increased significantly between 2009 and 2018, following 15 years of decline. 4 Considering the overall burden of gun violence, mass shootings are responsible for a relatively small number of deaths and injuries. However, these events also expose other residents, notably children, in the nearby communities to violence. This study examines the location of mass shootings relative to schools and places frequented by children, highlighting the potential risk of exposure to violence in our communities.
Purpose
To evaluate cumulative incidence of metastasis at specific timepoints after treatment of uveal melanoma in a large cohort of patients and to provide comparison of conditional outcomes in the youngest and oldest cohorts (extremes of age).
Methods
Retrospective analysis of 8091 consecutive patients with uveal melanoma at a single center over a 51-year period. The patients were categorized by age at presentation (0–29 years [n = 348, 4%], 30–59 years [n = 3859, 48%], 60–79 years [n = 3425, 42%], 80 to 99 years [n = 459, 6%]) and evaluated for nonconditional (from presentation date) and conditional (from specific timepoints after presentation) cumulative incidence of metastasis at five, 10, 20, and 30 years.
Results
For the entire population of 8091 patients, five-year/10-year/20-year/30-year nonconditional cumulative incidence of metastasis was 15%/23%/32%/36%, and the conditional incidence improved to 6%/15%/25%/30% for patients who did not develop metastasis in the first three years. For the extremes of age (0–29 years and 80–99 years), the nonconditional cumulative incidence of metastasis revealed the younger cohort with superior outcomes at 8%/15%/19%/27% and 21%/29%/29%/29%, respectively (
P
< 0.001). The conditional incidence (at one-year and two-year timepoints with metastasis-free survival) showed persistent superior younger cohort survival (
P
< 0.001,
P
= 0.001), but no further benefit for patients with three-year metastasis-free survival at 4%/12%/16%/24% and 7%/18%/18%/18%, respectively (
P =
0.09).
Conclusions
Non-conditional metastasis-free survival analysis for patients with uveal melanoma revealed the youngest cohort to have significantly better survival than the oldest cohort, and this persisted into one-year and two-year conditional metastasis-free survival but diminished at the three-year conditional timepoint.
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