Metastasis Risk After Biopsy for Posterior Uveal Melanoma
By Lynda Seminara
Selected By: Stephen D. McLeod, MD
Journal Highlights
Ophthalmology, December 2018
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Do the risks of biopsy in patients with uveal melanoma outweigh the benefits? Although some investigators have found a low frequency of ocular complications after such biopsies, the long-term risks have not been studied extensively. In a large longitudinal study spanning 32 years, Bagger et al. looked at the risk of metastasis after biopsy for posterior uveal melanoma. They found that rates of all-cause and melanoma-specific mortality were similar between biopsied and nonbiopsied patients.
This study included all patients with posterior uveal melanoma treated in Denmark between January 1985 and December 2016 (N = 1,637). Clinical and histopathologic findings for the study population were linked to pathology, cancer, and mortality registries. Patients had follow-up from diagnosis of choroidal or ciliary body melanoma until migration, death, or study conclusion (November 2017). Data included age, sex, tumor characteristics, and diagnostic and therapeutic measures.
The absolute risk of melanoma-specific death was denoted by cumulative incidence curves that accounted for competing risks. Cox regression models were applied to estimate crude and adjusted hazard ratios and 95% confidence intervals for all-cause mortality and melanoma-specific mortality among patients and to compare data between biopsied and nonbiopsied cohorts. Fine and Gray risk regression served as a sensitivity analysis of the effects of competing risks.
Of the 1,637 patients, 567 (35%) had a biopsy during primary treatment. At the time of diagnosis, those who received a biopsy had better prognostic factors, including smaller tumor size and younger age. Adjusted analyses showed no meaningful differences between the study groups in all-cause mortality or melanoma-specific mortality.
The original article can be found here.