Liverpool Ocular Oncology Service, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
Department of Eye and Vision Science and Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom; and.
Retina. 2020 Nov;40(11):2198-2206. doi: 10.1097/IAE.0000000000002763.
To investigate whether early detection and treatment of uveal melanoma by screening was associated with a lower mortality rate.
Retrospective assessment of prospectively collected data comparing 132 patients with uveal melanoma referred by the National Diabetic Screening Service with 608 control patients referred through other means.
Mean tumor diameter was smaller in the diabetic screening group (11.1 mm vs. 12.5 mm) as was tumor thickness (3.4 mm vs. 5.4 mm). The prevalence of high-risk monosomy 3 was also lower (17/40, 43% vs. 62/110, 56%). Despite a higher rate of systemic comorbidities in the patients diagnosed through screening and despite older age at diagnosis, the 5-year all-cause mortality was similar in both groups (17% vs. 20%); however, the metastatic mortality was lower in the diabetic screening group (11/132, 8% vs. 95/608, 16%).
Despite higher rates of comorbidities, the patients detected at diabetic screening had a lower 5-year mortality rate. The diabetic screening programme enabled detection and treatment of posterior uveal melanomas at an earlier stage. However, the confounding factors of lead and length time bias are not to be ignored.
研究通过筛查对葡萄膜黑色素瘤进行早期检测和治疗是否与降低死亡率相关。
回顾性评估前瞻性收集的数据，比较了通过国家糖尿病筛查服务转诊的 132 例葡萄膜黑色素瘤患者与通过其他途径转诊的 608 例对照患者。
糖尿病筛查组的平均肿瘤直径较小（11.1mm 比 12.5mm），肿瘤厚度也较小（3.4mm 比 5.4mm）。高危单体型 3 的患病率也较低（40 例中有 17 例，43%比 110 例中有 62 例，56%）。尽管筛查组患者的全身合并症发生率较高，且诊断时年龄较大，但两组的 5 年全因死亡率相似（17%比 20%）；然而，糖尿病筛查组的转移性死亡率较低（132 例中有 11 例，8%比 608 例中有 95 例，16%）。
尽管合并症发生率较高，但在糖尿病筛查中发现的患者 5 年死亡率较低。糖尿病筛查计划使后葡萄膜黑色素瘤能够更早地被发现和治疗。然而，需要注意的是，存在领先时间偏倚和长度时间偏倚的混杂因素。
