Bristol Eye Hospital, Lower Maudlin Street, Bristol BS1 2LX, UK.
Ophthalmology. 2012 Aug;119(8):1582-9. doi: 10.1016/j.ophtha.2012.01.048. Epub 2012 Apr 11.
To determine the mode of detection of uveal melanoma and time to treatment in the United Kingdom.
Prospective cohort study.
A total of 2384 patients diagnosed with uveal melanoma at the Liverpool Ocular Oncology Center between 1996 and early 2011.
A questionnaire was completed with every new patient, and the results were correlated with clinical features and treatment.
Tumor detection, practitioner initiating referral, referral pathway, time to treatment, baseline clinical features, and primary ocular treatment.
The referral process was initiated by an optometrist, family doctor, or ophthalmologist in 68.0%, 18.2%, and 13.8% of patients, respectively. On referral, 30.2% of patients were asymptomatic. Twenty-three percent of patients reported that their tumor was initially missed; these tended to have a more advanced tumor when they reached our center. The time from referral to treatment had a median of 49 days, exceeding 6 months in 19.8% of patients. This delay was longer in patients who reported that their tumor was missed (median, 92 vs. 40 days; Mann-Whitney, P<0.001). Ophthalmologists delayed the referral process by more than 6 months in 10.9% of patients. Primary enucleation was performed in 33.3% of patients and was more likely in those who reported that their tumor was missed (44.8% vs. 29.8%; chi-square, P<0.001).
Many patients with uveal melanoma experience long delays in treatment because their tumor was missed or misdiagnosed. Such patients tend to have a more advanced tumor by the time they reach an oncology center and are more likely to require enucleation.
确定英国葡萄膜黑色素瘤的检测方式和治疗时间。
前瞻性队列研究。
共有 2384 例在 1996 年至 2011 年初期间在利物浦眼部肿瘤中心被诊断为葡萄膜黑色素瘤的患者。
为每位新患者填写一份问卷，并将结果与临床特征和治疗相关联。
肿瘤检测、医生发起转诊、转诊途径、治疗时间、基线临床特征和主要眼部治疗。
转诊过程分别由验光师、家庭医生和眼科医生发起，占 68.0%、18.2%和 13.8%的患者。转诊时，30.2%的患者无症状。23%的患者报告其肿瘤最初被漏诊；这些患者到达我们中心时肿瘤往往更晚期。从转诊到治疗的中位时间为 49 天，超过 6 个月的患者占 19.8%。报告肿瘤漏诊的患者的延迟时间更长（中位数 92 天 vs. 40 天；Mann-Whitney，P<0.001）。10.9%的患者的眼科医生延迟转诊过程超过 6 个月。33.3%的患者进行了初次眼球摘除术，报告肿瘤漏诊的患者更可能进行该手术（44.8% vs. 29.8%；卡方检验，P<0.001）。
许多葡萄膜黑色素瘤患者的治疗存在长时间的延迟，因为他们的肿瘤被漏诊或误诊。这些患者到达肿瘤中心时往往肿瘤更晚期，更可能需要眼球摘除术。
