Arch Ophthalmol. 2003 Aug;121(8):1156-62. doi: 10.1001/archopht.121.8.1156.
To describe time trends, from 1987 through 1997, (1) in size of choroidal melanoma among patients with recent diagnosis confirmed at a clinical center that participated in the Collaborative Ocular Melanoma Study (COMS) and (2) in choice of treatment by patients who did not enroll in one of the COMS randomized trials.
Investigators at all COMS clinical centers (41 in the United States and 2 in Canada) agreed to report, in a masked fashion that did not include personal identifiers, all patients diagnosed as having choroidal melanoma during the accrual period for COMS randomized trials of radiotherapy. Information reported for patients who did not enroll in a COMS randomized trial included tumor dimensions, date of diagnosis, and initial treatment selected. Patients reported by centers that continued to report cases until 1997 and diagnosed as having choroidal melanoma no more than 1 year before evaluation at a participating COMS center contributed the data analyzed.
Time trends in tumor size among patients reported and in elective treatment of patients not enrolled in COMS randomized trials.
Of 8712 patients with choroidal melanoma examined, 6703 met criteria for analysis of time trend in tumor size and 4077 were analyzed for treatment trends over time. The number of cases with longest tumor basal diameter greater than 15.0 mm declined over time from 393 (30%) of 1330 cases reported in 1987 through 1989 to 345 (25%) of 1397 cases reported in 1996 or 1997. The proportion of patients eligible for COMS randomized trials who did not enroll and who elected enucleation remained stable over time for tumors of all sizes; the proportion of these patients who elected eye-conserving radiotherapy increased over time. Juxtapapillary tumors accounted for nearly half of the enucleations among ineligible patients who had tumors no larger than 15.0 mm in longest basal diameter.
Among patients examined at COMS centers during 1987 through 1997, the trends observed for patients with recently diagnosed choroidal melanoma included increasing presentation with tumors of smaller size, decreasing use of enucleation for choroidal melanoma 15.0 mm or less in longest basal diameter, and increasing use of such strategies for larger tumors.
描述1987年至1997年期间的时间趋势，（1）在一个参与协作性眼黑色素瘤研究（COMS）的临床中心确诊的近期脉络膜黑色素瘤患者中肿瘤大小的趋势，以及（2）未参加COMS随机试验之一的患者的治疗选择趋势。
所有COMS临床中心（美国41个，加拿大2个）的研究人员同意以不包含个人标识符的保密方式报告在COMS放射治疗随机试验的入组期间被诊断为患有脉络膜黑色素瘤的所有患者。为未参加COMS随机试验的患者报告的信息包括肿瘤尺寸、诊断日期和选择的初始治疗方法。由持续报告病例直至1997年且在参与的COMS中心评估前不超过1年被诊断为患有脉络膜黑色素瘤的中心报告的患者提供了分析数据。
报告患者的肿瘤大小的时间趋势以及未参加COMS随机试验患者的选择性治疗的时间趋势。
在8712例接受检查的脉络膜黑色素瘤患者中，6703例符合肿瘤大小时间趋势分析的标准，4077例分析了治疗随时间的趋势。肿瘤基底最长直径大于15.0 mm的病例数随时间减少，从1987年至1989年报告的1330例中的393例（30%）降至1996年或1997年报告的1397例中的345例（25%）。对于所有大小的肿瘤，未参加COMS随机试验且选择眼球摘除术的符合条件患者的比例随时间保持稳定；这些选择保留眼球放射治疗的患者比例随时间增加。在最长基底直径不超过15.0 mm的不符合条件患者中，近一半的眼球摘除术是由紧邻视乳头的肿瘤导致的。
在1987年至1997年期间在COMS中心接受检查的患者中，近期诊断为脉络膜黑色素瘤的患者呈现出的趋势包括较小尺寸肿瘤的就诊率增加、基底最长直径15.0 mm或更小的脉络膜黑色素瘤的眼球摘除术使用率降低，以及较大肿瘤的此类治疗策略使用率增加。
