Purpose

Biopsy of posterior uveal melanoma continues to be intensely debated in terms of the clinical benefits and safety profile. Although several studies have reported a low frequency of ocular complications after tumor biopsy, the potential long-term risk of iatrogenic dissemination remains unresolved. The purpose of this study was to assess the risk of metastatic disease after biopsy of posterior uveal melanoma.

Design

Retrospective nationwide cohort study linking clinical and histopathologic records to pathology, cancer, and mortality registries.

Participants

All patients with posterior uveal melanoma treated in Denmark between January 1985 and December 2016.

Methods

For each patient, we recorded detailed information on age, gender, tumor characteristics, and diagnostic and therapeutic measures, including tumor biopsy, if any, and the primary treating hospital. Absolute risk of melanoma-specific death was presented by cumulative incidence curves that accounted for competing risks. Cox regression models were used to estimate crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and melanoma-specific mortality of patients who underwent biopsy during primary treatment compared with nonbiopsied patients through November 1, 2017. Fine and Gray risk regression was used as a sensitivity analysis to evaluate the impact of competing risks.

Main Outcome Measures

All-cause and melanoma-specific mortality.

Results

Among 1637 patients, 567 (35%) underwent biopsy during primary treatment. At diagnosis, biopsied patients exhibited better prognostic characteristics, including smaller tumor size (P < 0.001) and younger age (P < 0.001), than nonbiopsied patients. In the adjusted analyses, we observed no apparent differences in all-cause mortality (HR, 1.07; 95% CI, 0.89–1.26; P = 0.47) or melanoma-specific mortality (HR, 1.11; 95% CI, 0.89–1.39; P = 0.35) among biopsied patients compared with nonbiopsied patients.

Conclusions

All-cause and melanoma-specific mortality after primary treatment were similar among biopsied and nonbiopsied patients with posterior uveal melanoma. Our findings do not support an increased metastatic risk after intraocular tumor biopsy.

中文翻译：

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后葡萄膜黑色素瘤活检后的长期转移风险

目的

关于葡萄膜后部黑色素瘤的活检在临床益处和安全性方面一直受到激烈的争论。尽管有几项研究报道肿瘤活检后眼部并发症的发生率较低，但医源性传播的潜在长期风险仍未解决。这项研究的目的是评估葡萄膜后黑色素瘤活检后转移性疾病的风险。

设计

回顾性全国队列研究将临床和组织病理学记录与病理学，癌症和死亡率登记表联系起来。

参加者

1985年1月至2016年12月在丹麦接受治疗的所有葡萄膜后黑素瘤患者。

方法

对于每位患者，我们记录了有关年龄，性别，肿瘤特征以及诊断和治疗措施的详细信息，包括肿瘤活检（如果有）和主要治疗医院。黑色素瘤特异性死亡的绝对风险通过累积发病率曲线来表示，这些曲线解释了竞争风险。使用Cox回归模型来估计截至2017年11月1日在初次治疗期间进行活检的患者与未进行活检的患者的全因和黑色素瘤特异性死亡率的粗略和调整后的危险比（HRs）和95％置信区间（CIs）。精细和灰色风险回归被用作敏感性分析，以评估竞争风险的影响。

主要观察指标

全因和黑色素瘤特异性死亡率。

结果

在1637例患者中，有567例（35％）在初次治疗期间进行了活检。在诊断时，活检患者表现出更好的预后特征，包括比非活检患者更小的肿瘤尺寸（P < 0.001）和更年轻的年龄（P < 0.001）。在调整后的分析中，我们观察到全因死亡率（HR，1.07； 95％CI，0.89–1.26；P  = 0.47）或黑素瘤特异性死亡率（HR，1.11； 95％CI，0.89–1.39； 5％）均无明显差异。 与未活检的患者相比，活检的患者中P = 0.35）。

结论

活检后和非活检后葡萄膜黑色素瘤患者的初次治疗后全因死亡率和黑色素瘤特异性死亡率相似。我们的发现不支持眼内肿瘤活检后转移风险的增加。