Artikel
Retrospective analysis of survival of patients with uveal melanoma in case of delayed enucleation
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Autoren
Veröffentlicht: | 22. September 2004 |
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Gliederung
Text
Objective
We sought to investigate the influence of eye enucleation delay (3 to 17 years) in case of uveal melanoma (UM) on patient survival.
Methods
Case-control and Kaplan-Meyer's methods were used for studying the degree of delayed treatment risk and the probability estimation of survival in the group of 37 patients with UM (uvea only), which were subjected (in 1965-1990 years) to enucleation on average 7 years, SD=3.7 (min 3 - max 17 years) after primary examination. Two reference groups of patients were picked out of the data base of over 4500 cases. Those groups contained patients (73-enucleation and 73-combined treatment), which were subjected to treatment in 1963 - 1990 immediately after the diagnosis. Each patient of the main group corresponded to the two patients in each reference group with identical (except for the criterion under investigation) features - age, sex, tumor localization, height, degree of pigmentation and cellular type, period of observation. The death of the patient was defined as "all-cause mortality". Mean age of the patient at this time was 50,6 years (SD = 15.2, min.-28, max-80).
Results
Out of 37 patients in the group with delayed enucleation 13 patients died, and in the group with primary enucleation 30 out of 73 patients died. OR=1.29 (95% CI is 0.57 - 2.93); therefore the risk of death was 29% higher in case of primary enucleation, but this was not statistically significant on the 5% level. 24 out of 73 patients died in the group with combined treatment (90Sr+photocoagulation), and, in accordance with data for delayed enucleation group the index OR=0.9 (95% CI is 0.39 - 7.07). Hence, the risk of death in case of conservative treatment was 10% lower, but the difference still was not significant on the 5% level. Comparing the survival of the patients in samples with Cox's F-Test showed, that there were no reliable difference in this parameter in both cases of delayed or primary enucleation (Cox's F-Test = 1.3; p=0.19) and delayed enucleation or combined treatment (Cox's F-Test = 1.03, p=0.46).
Conclusions
No significant differences in the survival function in case of UM with delay enucleation or treated other methods of treatment were revealed. Statistical power of this case-control study is low because of small size of case group. But nevertheless, there is a question: whether enucleation always is necessary at UM at aged patients?