School of Medicine Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
School of Medicine Baylor College of Medicine, Houston, Texas, USA.
Curr Eye Res. 2022 Apr;47(4):634-641. doi: 10.1080/02713683.2021.2018465. Epub 2022 Jan 27.
Although incidence of second primary malignancies (SPMs) has been investigated in patients with cutaneous melanoma and uveal melanoma, limited studies have investigated their occurrence subsequent to conjunctival melanoma (CM). We conducted a retrospective observational study to assess incidence of SPMs in patients with primary CM and to identify associated risk factors.
Cases of first primary CM diagnosed from 2000 to 2018 were extracted from the national cancer database Surveillance, Epidemiology, and End Results Program. Standardized incidence ratios (SIR) and excess absolute risk (EAR) of SPMs were calculated compared to a matched cohort from the general population with similar sex, race, age group, and calendar year. EAR was per 10,000 individuals, and a -value of <0.05 was considered significant.
A total of 471 patients met inclusion criteria, 57 (12.1%) of whom developed second primary malignancies (excluding eye and orbit melanomas) over an average (±SD) follow-up period of 6.8 (±5.0) years. Average age at diagnosis for the overall cohort was 60.2 (±18.6) years. Patients with CM demonstrated a significantly increased risk for overall SPMs relative to the general population, even after excluding eye and orbit melanomas (SIR 1.52; 95% confidence interval [CI], 1.15-1.97; EAR 67.58). Specific sites and malignancy types with increased risk were cutaneous melanoma (SIR 7.95; 95% CI, 4.45-13.12; EAR 45.34), ophthalmic non-melanoma malignancies (SIR 80.92; 95% CI, 2.05-450.84; EAR 3.41), and non-intrahepatic biliary malignancies (SIR 11.72; 95% CI, 1.42-42.32; EAR 6.32). Risk of overall SPMs (excluding eye and orbit melanomas) was significantly increased 5-10 years from diagnosis date.
Patients with CM had an increased incidence of SPMs compared to the general population. Specifically, these patients developed more cutaneous, ophthalmic non-melanoma, and non-intrahepatic biliary malignancies. These second neoplasms could be due to shared pathophysiology or mutual risk factors. Patients with CM may benefit from surveillance for SPMs, such as annual age-appropriate screenings in the first 10 years after diagnosis.
虽然已经有研究调查了皮肤黑色素瘤和葡萄膜黑色素瘤患者的第二原发恶性肿瘤（SPM）的发病率，但很少有研究调查过结膜黑色素瘤（CM）后 SPM 的发生情况。我们进行了一项回顾性观察研究，以评估原发性 CM 患者 SPM 的发生率，并确定相关的危险因素。
从国家癌症数据库监测、流行病学和最终结果计划中提取了 2000 年至 2018 年诊断的原发性 CM 病例。与具有相似性别、种族、年龄组和日历年份的一般人群相匹配的队列相比，计算 SPM 的标准化发病比（SIR）和超额绝对风险（EAR）。EAR 为每 10000 人，a 值<0.05 被认为有统计学意义。
共有 471 名患者符合纳入标准，其中 57 名（12.1%）在平均（±SD）6.8（±5.0）年的随访期间发生了第二原发恶性肿瘤（不包括眼部和眼窝黑色素瘤）。总体队列的平均诊断年龄为 60.2（±18.6）岁。与一般人群相比，CM 患者发生 SPM 的风险明显增加，即使排除眼部和眼窝黑色素瘤后也是如此（SIR 1.52；95%置信区间[CI]，1.15-1.97；EAR 67.58）。风险增加的特定部位和恶性肿瘤类型包括皮肤黑色素瘤（SIR 7.95；95%CI，4.45-13.12；EAR 45.34）、眼非黑色素瘤恶性肿瘤（SIR 80.92；95%CI，2.05-450.84；EAR 3.41）和非肝内胆管恶性肿瘤（SIR 11.72；95%CI，1.42-42.32；EAR 6.32）。从诊断日期起 5-10 年后，总体 SPM（不包括眼部和眼窝黑色素瘤）的风险显著增加。
与一般人群相比，CM 患者 SPM 的发病率增加。具体而言，这些患者发生了更多的皮肤、眼非黑色素瘤和非肝内胆管恶性肿瘤。这些第二肿瘤可能是由于共同的病理生理学或共同的危险因素所致。CM 患者可能受益于 SPM 的监测，例如在诊断后 10 年内每年进行适合年龄的筛查。
