title: Second Primary Neoplasms in Patients With Uveal Melanoma: A SEER Database Analysis.
abstract: To determine the risk of second primary neoplasms (SPNs) in subjects previously diagnosed with uveal melanoma (UM), including an analysis on whether radiotherapy is a risk factor to develop these SPNs.
  
  
  
  Retrospective cohort study.
  
  
  
  Using the Surveillance, Epidemiology, and End Results (SEER) 9 database, we identified patients diagnosed with UM as their first malignancy between 1973 and 2011 (n = 3976). We obtained standardized incidence ratios (SIR) and excess absolute risks of SPNs on patients with UM compared to a reference population. Multivariate Cox regression models were used to evaluate the effect of radiotherapy in SPN risk.
  
  
  
  Sixteen percent (n = 641) of the patients developed SPNs during a median follow-up of 83 months (range, 1-463 months). This represented an 11% excess risk compared to the reference population, mainly owing to a significantly increased risk of skin melanomas (SIR = 2.93, 95% CI: 2.23-3.78) and kidney tumors (SIR = 1.91, 95% CI: 1.27-2.76), primarily in those diagnosed between 30 and 59 years of age. The occurrence of second UM was also increased (SIR = 16.90, 95% CI: 9.00-28.90), which likely includes recurrences misclassified as a second cancer. Radiotherapy was performed in 39% (n = 1538) of the patients. Multivariate analysis revealed that this treatment was not an independent risk factor for SPNs (hazard ratio = 1.06, 95% CI: 0.88-1.26, P = .54).
  
  
  
  Patients with UM presented an 11% higher risk of SPNs compared to the reference population. Radiotherapy does not seem to be a risk factor. SPNs should be considered in the surveillance of UM.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Laíns
authors.affiliation: Department of Pathology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Bartosch
authors.affiliation: Department of Anesthesiology, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal.
authors.forename: Vera
authors.initials: V
authors.lastname: Mondim
authors.affiliation: Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Brian
authors.initials: B
authors.lastname: Healy
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ivana K
authors.initials: IK
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. Electronic address: Deeba_Husain@meei.harvard.edu.
authors.forename: Deeba
authors.initials: D
authors.lastname: Husain
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Joan W
authors.initials: JW
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000532:radiotherapy; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014604:Uveal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D000098943:Uveal Melanoma