Additional malignancies and mortality in uveal melanoma: A 20‐year follow‐up of a Norwegian patient cohort

Abstract

Purpose The purpose of this study is to explore the frequency of additional primary malignancies in uveal melanoma (UM) patients and cause‐specific mortality, to help guide surveillance strategies after UM. Methods All patients diagnosed with UM at Oslo University Hospital during 1990–2017 were eligible for inclusion. Linkage to the Cancer Registry of Norway obtained information on additional malignancies and cause of death throughout 2019. UM patients were categorized according to timing of additional malignancy (prior/simultaneously or after UM) or no additional cancer, and by UM stage at diagnosis. Age‐adjusted mortality rates were presented per 1000 person‐years with 95% confidence intervals (CI). Results The study population included 960 UM patients: 77% were diagnosed in stage and I/II and 56% were men. Mean age at diagnosis was 63 years. Additional malignancies were observed in 152 patients prior/simultaneous to UM, and in 120 patients >1 year after UM. Overall, mortality per 1000 person‐years was 3.5 (95% CI 3.1–3.9) for UM and 3.0 (2.6–3.4) for other causes. Lowest UM mortality [1.3 (0.60–2.1)] was seen in patients with a second malignancy after UM, regardless of stage. Highest UM mortality was seen for UM patients in stage III/IV, both without [16.1 (13.2–19.1)] and with any additional malignancy [16.9 (6.6–27.3)]. Conclusion Our results support that UM patients frequently have additional malignancies, both before and after UM. Low‐UM mortality in patients with a primary malignancy after UM, might indicate less aggressive UM. The cumulative UM mortality flattens about 10 years after diagnosis and annual follow‐up of patients for 10 years seems adequate.

Additional primary malignancies in a Polish cohort of uveal melanoma patients: a review of 644 patients with long-term follow-up

“…It may be speculated that this is because this type of UM seems to have better prognosis, therefore with longer survival there might be a higher possibility of developing other cancers, just as in a healthy population. Interestingly, other recently published report in this subject confirms the same observation [ 24 ].…”

“…According to some authors, the incidence is no different than in the healthy population, with rates lower than 10% [ 20 , 22 , 30 , 31 ]. On the contrary, there are other reports suggesting that the frequency of additional malignancies is higher for the UM patients with an approximately 11% higher risk than in healthy subjects [ 7 , 12 , 13 , 15 , 34 ], ranging to even more than 20% in Scandinavian population [ 17 , 24 ]. In our cohort the additional malignancy was diagnosed in 20% of registered UM patients.…”

“…Of note, in UM patients, the presence of somatic BAP-1 mutations in tumour cells increases the risk of metastasis and worsens prognosis [ 6 , 14 ]. However, the frequency of germline BAP1 mutations according to many groups is low, about 2%, and cannot be related to higher frequency of additional primary malignancies [ 23 , 24 ].…”