Risk of New Primary Cancer in Patients with Posterior Uveal Melanoma: A National Cohort Study

Abstract

Background: Studies on the risk of new primary cancer in patients with posterior uveal melanoma (UM) have produced conflicting results, and the role of socioeconomic status (SES) is unknown. The purpose of this population-based matched cohort study was to determine the risk of new primary cancer following the diagnosis of posterior UM. Methods: 2179 patients with posterior UM 1968–2016 and 22,717 matched controls without cancer were included. Incidence and time-dependent hazard ratio (HR) of new primary cancer were described, and the effect of SES was emphasized in a sub-cohort. Results: The incidence of new primary cancer was increased in patients with posterior UM, rate ratio (RR) 1.21 (95% CI: 1.08; 1.35), but the specific cancer types did not differ compared to the controls. The rate of new primary cancer following the diagnosis of posterior UM was significantly increased 2–5 years (HR 1.49 (95% CI: 1.23; 1.80)) and 11–15 years (HR: 1.49 (95% CI: 1.12; 1.99)), and adjusting for SES did not change the rate (HR 1.35 (95% CI:1.20; 1.55)). Conclusions: Patients with posterior UM have an increased risk of new primary cancer independent of SES. No difference in incidence of specific cancer type was observed compared to the control group.

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

“…Compared to the recently published study from Denmark (Bagger et al, 2022), our material had a higher proportion of patients in stage I (26% vs. 17%), and lower proportions in stage III/IV (23% vs. 27%) and unspecified (0.1% vs. 4%). Inclusion to our patient cohort started two decades later than the Danish study.…”

“…Compared with non-cancer controls, cancer survivors undergo more screening examinations during surveillance (Corkum et al, 2013) and knowledge about malignant comorbidity in UM patients may increase awareness in medical surveillance after UM that can reveal additional malignancies. To date, however, there are no evidence-based guidelines for surveillance of new primary cancer during follow-up of UM patients (Bagger et al, 2022). Although neither the Swedish nor the Danish study found significantly increased risk for any specific cer type, the most frequent additional cancers were of breast, prostate, colorectum, lung and skin, which also was seen in our data.…”

“…Our cohort consisted predominantly of men, with a slightly higher proportion than reported from population‐based data from US (Laíns et al, 2016), Sweden (Bergman et al, 2002), and Denmark (Bagger et al, 2022). We have no explanation for this difference.…”

“…However, compared to the reference population, the excess cancer risk was 11%. A Swedish population-based study found a 13% elevated risk of subsequent cancer when comparing UM patients with the general population (Bergman et al, 2006), and, in Denmark, a 21% elevated cancer risk following UM has been reported (Bagger et al, 2022). In comparison, a population-based U.S. study found that 8.1% of cancer survivors from the 10 most common cancers developed a second primary malignancy (Donin et al, 2016).…”

“…Follow‐up studies have reported multiple malignancies in patients with UM, but the frequency varies (Bagger et al, 2022; Bergman et al, 2006; Callejo et al, 2004; Diener‐West et al, 2005; Heussen et al, 2016; Laíns et al, 2016). Recently, a Danish nationwide cohort study showed a 21% increased incidence of a new primary cancer following a posterior UM, although not restricted to specific cancer forms (Bagger et al, 2022). Screening for metastases at diagnosis of primary UM has shown that about 3% had simultaneously another cancer (Freton et al, 2012).…”