---
title: "Choroidal metastasis: Age and metastatic burden predict survival in a single-center cohort"
id: "plos-one-12-choroidal-metastasis-impact-of-primary-tumors-and-age-on-survival-a-single"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-12-choroidal-metastasis-impact-of-primary-tumors-and-age-on-survival-a-single"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0354598"
published_at: "2026-07-27T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Choroidal metastasis: Age and metastatic burden predict survival in a single-center cohort
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-12-choroidal-metastasis-impact-of-primary-tumors-and-age-on-survival-a-single
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0354598)
- **Published At:** 2026-07-27T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This single-center retrospective study reviewed 70 patients diagnosed with **choroidal metastasis** between August 2013 and October 2025 to evaluate the impact of **primary tumor type** and **age** on overall survival. - Clinical data and multimodal imaging (fundus photography, OCT, ultrasonography, autofluorescence, angiography when needed) were extracted from medical records; tumor volume was calculated from B-scan ultrasound using an ellipsoidal model. - Primary tumors were grouped as lung, breast, or other primaries for survival comparisons; patients with bilateral metastases contributed right-eye data only. - Median overall survival from choroidal metastasis diagnosis was 71.6 weeks for the cohort. - Younger patients (<59.6 years) had significantly longer median survival (88.3 weeks; estimated 3-year survival 33.2%) than older patients (≥59.6 years) who had median survival 41.9 weeks and 3-year survival 16.8% (p = 0.037). - Median survival by primary tumor: breast cancer 94.4 weeks (estimated 3-year survival 38.3%), lung cancer 52.7 weeks (9.5%), and other primaries 40.6 weeks (19.7%); these differences were not statistically significant (p = 0.269). - Multivariate Cox regression identified age ≥59.6 years (HR 2.10; p = 0.016) and having more than one extraocular metastatic site (HR 2.53; p = 0.029) as independent predictors of increased mortality. - The study concludes that **age** and the number of **extraocular metastatic sites** on presentation are stronger prognostic indicators than the primary tumor category in patients with choroidal metastases. - Data cannot be publicly shared due to ethical/legal restrictions, but anonymized data are available on reasonable request per the institutional ethics committee.
## Clinical Analysis & Structured Key Points
Choroidal metastasis: Impact of primary tumors and age on survival - a single center analysis | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Purpose The purpose of this study was to determine whether patient’s age and their primary tumor type act as independent predictors of their survival after a diagnosis of choroidal metastasis. Methods This retrospective single-center study (August 2013 – August 2025) included 70 patients with choroidal metastases. Clinical data and multimodal imaging were extracted from medical records. Tumor volume was calculated from ultrasound measurements. Patients were grouped according to primary tumor origin (lung, breast, or other primaries). Survival was compared between these three primary tumor groups and according to age. Group differences in continuous variables were assessed using ANOVA/Kruskal-Wallis testing, and survival distributions were analyzed with Kaplan-Meier curves. Patients were categorized into younger ( 1 extraocular metastases elsewhere in the body (HR 2.53; p = 0.029) were independent predictors of mortality. Conclusion Survival in choroidal metastases is strongly driven by age and the number of extraocular metastatic sites at presentation. Our findings suggest that younger age and a lower metastatic burden are most reliable indicators for a more favorable prognosis. Citation: Fuchs P, Reumueller A, Kreminger J, Zafeiri E, Sacu S, Told R, et al. (2026) Choroidal metastasis: Impact of primary tumors and age on survival - a single center analysis. PLoS One 21(7): e0354598. https://doi.org/10.1371/journal.pone.0354598 Editor: Carmelo Caldarella, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, ITALY Received: April 23, 2026; Accepted: July 9, 2026; Published: July 27, 2026 Copyright: © 2026 Fuchs et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The data underlying the results presented in this study cannot be shared publicly due to ethical and legal restrictions regarding patient privacy. The study protocol, approved by the Ethics Committee of the Medical University of Vienna (EK-Nr: 1401/2022), mandates that patient data be stored in a secure, password-protected database and does not permit public deposition. However, anonymized data are available upon reasonable request for researchers who meet the criteria for access to confidential clinical data. Requests for data access can be directed to the institutional Ethics Committee of the Medical University of Vienna ( ethik-kom@meduniwien.ac.at ) or the corresponding author( reinhard.told@meduniwien.ac.at ). Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Introduction Although metastases are common in both lung and breast cancer, ocular involvement is rare. In breast cancer it occurs in 0.5% of cases and represents 2–3% of metastatic presentations, most often choroidal or orbital [ 1 ]. Lung cancer is also a major source of intraocular metastases, again predominantly to the choroid, but absolute incidence remains low relative to the total burden of metastatic disease [ 2 , 3 ]. It has been reported that 1–7% of patients with lung cancer develop intraocular metastasis [ 4 , 5 ]. Despite being relatively rare, intraocular metastases represent the most prevalent type of intraocular malignancy in adults [ 6 , 7 ]. An estimated 1–2% of all cancer patients develop intraocular metastases, with higher rates detected histologically than clinically [ 8 ]. The choroid represents the primary site of metastatic involvement (90%), followed by iris (8%) and ciliary body (2%) [ 6 ]. The highly vascular and low-flow characteristics make the uveal tract susceptible to metastatic tumor cell deposition [ 9 , 10 ]. In rare cases, manifestations may also appear in the retina, optic disc, vitreous and lens capsule [ 11 – 15 ]. Uveal metastasis predominantly originate from primary cancer of the breast (37–47%), lung (21–50%), with other less common origins including kidney, gastrointestinal tract, cutaneous melanoma, lung carcinoid, prostate, thyroid, pancreas and other sites [ 6 , 16 – 18 ]. The overall prognosis is unfavorable, with a 5-year survival rate of 24%. Patients with pancreatic metastases have the poorest survival (mean, 4.2 months), whereas those with lung carcinoid metastases demonstrate the most favorable prognosis (92% at 5 years) [ 19 ]. Median survival after diagnosis of choroidal metastasis is 10–12 months for breast and lung cancer [ 6 ]. This study aims to provide a comprehensive overview of choroidal metastases of a single center and to report characteristics in relation to primary tumor type and patient age at choroidal metastasis diagnosis, and further to evaluate survival outcomes. Methods This retrospective study was conducted at the Department of Ophthalmology and Optometry, Medical University of Vienna. Data were collected retrospectively from medical records and imaging databases of consecutive patients diagnosed with choroidal metastasis between August 2013 and July 2025. The study was approved by the Institutional Review Board by the Medical University of Vienna (Vienna, Austria) Ethics Committee (EK 1401/2022), which waived the requirement for informed consent due to the retrospective nature of the study. Medical records were accessed for research purposes between December 01, 2025, and January 31, 2026. During the initial data collection phase, the authors (P.F. and E.Z.) had access to information that could identify individual participants. However, all data were pseudonymized prior to statistical analysis, and no identifying information was included in the final dataset or used in this report to ensure data security and participant anonymity. The study was conducted in adherence with the principles of the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Inclusion criteria were clinical and/or imaging-based diagnosis of choroidal metastasis, patients with known or unknown primary malignancy, availability of medical records and follow-up period within the timeframe August 2013 – October 2025. Patients were excluded if they had primary uveal melanoma, iris or ciliary body metastasis, or no follow-up information available. Patients who had metastasis in both eyes were included with data from right eyes only. Examinations were conducted by experienced ocular oncologists using slit-lamp biomicroscopy and multimodal imaging at each visit. The diagnosis of choroidal metastasis was established based on characteristic clinical and imaging features. Imaging modalities included wide-field fundus photography, ultrasonography, fundus autofluorescence, and optical coherence tomography (OCT), complemented by fluorescein, indocyanine green, and OCT angiography when clinically required. Demographic information included age (years) and sex (male/female). Collected data comprised the clinical features of choroidal metastasis, the applied treatment (methods), and information regarding the primary tumor, including its treatment before the diagnosis of metastasis and time of death. Death dates (and, where available, ICD-10 causes of death) were obtained via the Sterbedatenabgleich service (Death data linkage) of the Medical University of Vienna, which matches patient records with the official death data from Statistik Austria [ 20 ]. Clinical features included tumor dimensions and the presence of retinal fluid or retinal detachment in slit lamp examination. Data describing tumor dimensions were extracted from B-scan ultrasonography. Ultrasonographic measurements included one transverse still frame through the apex of the lesion and one longitudinal still frame encompassing the greatest tumor extent. Imaging was performed using a 20-MHz probe for intraocular assessment. Measurements were obtained with the system’s caliper function. Tumor diameters on transverse and longitudinal scans were defined as straight lines between opposing tumor borders, while tumor thickness was measured from the apical tumor surface to the inner scleral boundary. Tumor dimensions were recorded as thickness (mm), width (mm, transverse/tangential), and length (mm, longitudinal). Tumor volume (mm³) was calculated using the ellipsoidal model formula: (π/6 × length × width × height) [ 21 ]. Statistics All groups were tested before statistical analysis for normal distribution using Kolmogorov Smirnoff test. If data was normally distributed, a one-way ANOVA was performed; otherwise, the Kruskal-Wallis test was used. Statistical analyses were performed using SPSS (Version 29.0. Armonk, NY: IBM Corp., USA). Choroidal metastases originating from 14 subgroups of primary tumors were analyzed. Overall survival was calculated from date of first diagnosis of choroidal metastasis until death. Survival distributions were generated using the Kaplan-Meier method and group differences in survival were assessed with the log rank test. Patients who were alive at the time of the last follow-up or were lost to follow-up were right-censored at the date of their last clinical examination. Comparisons were made by primary tumor type and age. For Kaplan-Meier and Cox regression analyses, primary tumors were categorized into three groups to ensure adequate sample sizes and reliable survival estimates: Group 1 included all patients with primary lung cancer (metastatic non-small-cell and small-cell carcinoma). Group 2 included primary breast cancer (all metastatic mammary carcinomas). Group 3 included all other primary tumors gastrointestinal (colorectal and pancreatic), genitourinary (renal, prostate, bladder and gynecologic; each being metastatic), and head and neck/endocrine/melanoma primaries. Cox Regression Analysis To identify independent predictive factors associated with overall survival, a multivariate Cox proportional hazards regression model was performed. Continuous variables included age at the time of choroidal metastasis diagnosis, tumor volume and height, while categorical variables included number of other non-ocular metastasis elsewhere in the body (≤1 vs. > 1), tumor classification (lung, breast, or others), presence of subretinal fluid/retinal detachment (yes/no), systemic therapy prior to metastasis (yes/no), and order of diagnosis (eye first vs. primary tumor first). Univariate Cox regressions were conducted first to screen for potential predictors. In univariate Cox regression analyses, age at metastasis was analyzed as a continuous variable to assess the general effect of increasing age on survival. For multivariate modeling, age was dichotomized at the sample median (59.6 years) to facilitate clinical interpretation and maintain balanced group sizes. Variables with a significance level of p < 0.15 in univariate analyses or with strong clinical relevance were entered into the multivariate Cox model. Sex was excluded from the multivariate analysis due to its complete overlap with tumor classification (all breast cancer patients were female), which would otherwise introduce collinearity. The number of non-ocular metastases elsewhere in the body was tested in univariate analysis. Despite the small subgroup size (n = 13, eyes with 0 or 1 non-ocular metastasis elsewhere in the body), the variable was retained in the multivariate model due to its biological relevance as a marker of disease burden. Consequently, results should be interpreted with caution. Results were expressed as hazard ratios (HR) with 95% confidence intervals (CI), and a p-value less than 0.05 was considered statistically significant. Results This study included a total number of seventy patients and seventy eyes, with ten patients presenting choroidal metastases in both eyes. Baseline primary tumor type classification of the patient cohort are presented in Table 1 , while demographic characteristics are summarized in Table 2 . The clinical characteristics of patients with choroidal metastasis are described in Table 3 . There were statistically significant differences in mean age at diagnosis of metastasis (p = 0.021) and systemic therapy prior to choroidal metastasis diagnosis (p = 0.013). Age at diagnosis of choroidal metastasis was statistically significantly lower in patients diagnosed with breast cancer as compared to lung cancer (mean difference = 8.77 years, p = 0.024), this difference did not remain statistically significant for multiple comparisons using the Bonferroni correction (adjusted α = 0.017). Systemic therapy prior to metastatic presentation was significantly more common in breast cancer than in lung cancer (p = 0.005) (Bonferroni-adjusted α = 0.013). Download: PNG larger image TIFF original image Table 1. Classification of primary tumors according to organ systems. https://doi.org/10.1371/journal.pone.0354598.t001 Download: PNG larger image TIFF original image Table 2. Demographic characteristics of patients with choroidal metastasis. Values are presented as mean ± standard deviation (SD) and median with interquartile range (IQR). The asterisk (*) indicates statistical significance at p < 0.05*. https://doi.org/10.1371/journal.pone.0354598.t002 Download: PNG larger image TIFF original image Table 3. Clinical characteristics of patients with choroidal metastasis. Values are presented as mean ± standard deviation (SD) and median with interquartile range (IQR). The asterisk (*) indicates statistical significance at p < 0.05*. https://doi.org/10.1371/journal.pone.0354598.t003 For the analysis of ultrasound tumor dimensions, measurements were available of 59 patients for width, 58 for length, 62 for height, and 58 for volume. The analysis of tumor dimensions revealed no significant differences regarding width (p = 0.613, ANOVA) or length (p = 0.813) between the three primary tumor groups. Tumor height differed statistically significantly between groups (Kruskal-Wallis test, p = 0.007), whereas no significant difference was observed for tumor volume (p = 0. 794). Post-hoc pairwise comparisons (Mann-Whitney U test) showed statistically significant differences in height between the lung cancer and the breast cancer group (p = 0.038), and between group 2 (breast cancer) and group 3 (other tumors) (p = 0.002). However, after Bonferroni correction for multiple testing (adjusted α = 0.017), the only statistically significant difference remaining was between breast and the “other” group; whereas the difference between breast and lung cancer group lost statistical significance. There was a statistically significant difference in SRF visible in the three subgroups (p < 0.001). Pairwise comparisons were adjusted using the Bonferroni correction (α = 0.017). SRF was significantly more frequent in lung cancer compared with breast cancer (p < 0.001) and in the “other” tumor group compared with breast cancer (p = 0.014), whereas lung cancer and the “other” group did not differ significantly (p = 0.345). Kaplan Meier Survival depending on Primary Tumor Types At the time of analysis, 48 of 70 patients (68.6%) had deceased. Event occurrence of death by primary site was 19/28 (67.9%) in lung cancer, 14/23 (60.9%) in breast cancer, and 15/19 (78.9%) in other tumors. The mean survival time was 115.3 weeks for lung cancer, 205.7 weeks for breast cancer, and 112.3 weeks for other primary tumors. Median survival was 52.7, 94.4, and 40.6 weeks. For the whole study group, the mean survival time was 158.2 weeks, and the median was 71.6 weeks. The mean observation period from the diagnosis of choroidal metastasis until death or last follow-up was mean 92.9 weeks (SD 120.18 weeks). There was no statistically significant difference in overall survival between the three groups (p = 0.269). The estimated 1-year survival rate was 53.6% in lung cancer, 76.2% in breast cancer and 42.1% in the other primary tumor group. At 3-years, the estimated survival rate was approximately 9.5% for the lung cancer group, 38.3% for the breast cancer group, and 19.7% for the other tumor group. At 5-years, the estimated survival rate was approximately 9.5% for the lung cancer group, 25.5% for the breast cancer group, and 19.7% for the other tumor group. The estimated overall 1-year, 3-years and 5-years survival rates for the whole study cohort were approximately 56%, 24% and 18%. The Kaplan Meier survival curve can be seen in Figure 1 . Download: PNG larger image TIFF original image Fig 1. Kaplan Meier survival curves according to primary tumor group: 1 (blue) lung cancer, 2 (red) breast cancer, 3 (green) other tumors. https://doi.org/10.1371/journal.pone.0354598.g001 Kaplan Meier Survival in Age When dichotomizing age at the group median (59.6 years), 32 patients were classified as younger and 38 as older than the median. At the time of analysis, 18/32 younger patients (56.3%) and 30/38 older patients (78.9%) had experienced the event (death). The mean survival time was 209.5 weeks (median 88.3 weeks) for patients younger than 59.6 years, and 118.7 weeks (median 41.9 weeks) for those aged 59.6 years or older. The estimated 1-year, 3-years and 5-years survival was approximately 70.5%, 33.2% and 26.5% in patients younger than 59.6 years and 46.2%, 16.8% and 12.6% in patients aged ≥59.6 years. According to the Log-Rank test, the difference in survival between the two age groups was statistically significant (p = 0.037), indicating a longer survival in the younger group. The Kaplan Meier survival curve can be seen in Figure 2 . Download: PNG larger image TIFF original image Fig 2. Kaplan Meier survival curves according to age group (median split at 59.6 years), blue: younger (<59.6years) red: older (≥59.6 years). https://doi.org/10.1371/journal.pone.0354598.g002 Univariate Cox regression analysis Univariate Cox regression analyses were conducted to identify variables associated with overall survival. Variables were selected based on clinical relevance and prior evidence from the literature. A trend toward reduced survival was observed with increasing age at metastasis (HR = 1.025; 95% CI 0.999–1.051; p = 0.056). Patients with more than one non-ocular metastasis elsewhere in the body had an approximately 1.9-fold higher risk of death compared to those with a single or no metastasis elsewhere in the body (HR = 1.87; 95% CI 0.83–4.18; p = 0.129). Both variables were therefore included in the multivariate model. Tumor classification (lung, breast, or others) was not significantly associated with survival ( p = 0.276) but was included due to biological plausibility. Sex was not a significant predictor (HR = 1.53; 95% CI 0.86–2.74; p = 0.148) and was excluded from the multivariate model due to collinearity with tumor type (all breast cancer patients were female).
## Related Clinical Research

- [GLUT10 (SLC2A10) Expression in Breast Cancer and Its Role in Cisplatin Resistance](https://medichelpline.com/clinical-feed/pubmed-42595549.md) (DOI: 10.3760/cma.j.cn112152-20251018-00521)
- [Challenging FDA-Approved Cancer Drug Dosages: A Patient and Research Perspective](https://medichelpline.com/clinical-feed/kff-health-news-2-how-much-of-a-cancer-drug-is-too-much-patients-researchers-challenge-fda.md)
- [Predicting Cancer Immunotherapy Response Using Dynamic CD8+ T Cell Changes — Pan‑Cancer Retrospect](https://medichelpline.com/clinical-feed/frontiers-in-immunology-13-a-predictive-model-for-immunotherapy-efficacy-in-cancer-based-on-dynamic.md)
- [CT-guided intratumoral immunotherapy for advanced solid tumors: safety and systemic effects](https://medichelpline.com/clinical-feed/frontiers-in-immunology-3-ct-guided-intratumoral-immunotherapy-for-advanced-solid-tumors-a-prospective.md)
- [Directional coating of cell membranes preserves orientation and extends circulation of biomimetic](https://medichelpline.com/clinical-feed/pubmed-42508509.md) (DOI: 10.1016/j.ijpharm.2026.127241)

## Navigation
- [← Back to Oncology Feed](https://medichelpline.com/clinical-feed/oncology.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.