Zimmerman L E, McLean I W, Foster W D
Ophthalmology. 1980 Jun;87(6):557-64. doi: 10.1016/s0161-6420(80)35196-8.
Reappraisal of follow-up data obtained on patients whose uveal melanomas were treated by enucleation before 1955 has led to the conclusion that the operation may have had an adverse effect, accelerating dissemination and a lethal outcome, especially among patients whose tumors were large and/or contained epitheloid cells. The temporal relationship of tumor deaths to enucleation is demonstrable regardless of whether calculations represent "death density" or "hazard" functions. Use of an inferred natural history model suggests that uveal melanomas are slowly growing neoplasms. An average of seven to eight years is required for small tumors to become large and an additional period of four years before metastatic diseases might be anticipated. The eye is exceptionally vulnerable to great fluctuations in tissue pressure that may account for iatrogenic spread of tumor cells during a variety of manipulations before and during enucleation. Research to prevent dissemination by improved management is indicated.
对1955年前接受眼球摘除术治疗的葡萄膜黑色素瘤患者的随访数据重新评估后得出结论，该手术可能产生了不良影响，加速了肿瘤扩散和致死结局，尤其是在肿瘤体积大及/或含有上皮样细胞的患者中。无论计算采用“死亡密度”还是“风险”函数，肿瘤死亡与眼球摘除术之间的时间关系都是可证明的。使用推断的自然病史模型表明，葡萄膜黑色素瘤是生长缓慢的肿瘤。小肿瘤平均需要七到八年才能长大，在预计发生转移性疾病之前还需要额外四年时间。眼球对组织压力的巨大波动异常敏感，这可能解释了在眼球摘除术前和术中的各种操作过程中肿瘤细胞的医源性扩散。因此，有必要开展研究以通过改进治疗方法来防止肿瘤扩散。
