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Z. M. Correa, J. J. Augsburger, C. C. Simoes; Reinterpreting the Evidence: Is Better Survival of Patients With Smaller Uveal Melanomas Evidence of a Treatment Benefit?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3807.
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Patients with smaller posterior uveal melanomas at the time of treatment are known to have a substantially better survival prognosis than those with larger tumors. Many physicians interpret this information as evidence of a survival benefit of earlier versus later treatment. The purpose of this study was to evaluate currently available evidence in the peer reviewed literature to see if this interpretation is valid scientifically.
The authors identified, obtained and reviewed articles in the peer reviewed literature (1980-2009) that (1) evaluated tumor size as a prognostic factor for metastasis or metastatic death in patients with posterior uveal melanoma and/or (2) commented on early treatment of identified intraocular tumors. Comments about the impact of tumor treatment in smaller versus larger tumors were recorded and summarized.
Two hundred and sixty nine relevant articles were identified using the PubMed search engine. Multiple groups were documented to have reported that patients with smaller tumors at treatment have better survival than those with larger tumors. Ten articles, including one from the COMS, contained statements indicating the author’s belief that treatment was likely to prevent metastasis if it were provided when the intraocular tumor was small or that delay in treatment was likely to worsen survival substantially. No published report of a phase III randomized clinical trials of treatment versus no treatment for any substage of primary uveal melanoma was identified by this study.
Although the better survival of patients with smaller uveal melanomas is commonly interpreted as surrogate evidence for a benefit of earlier versus later treatment, this interpretation is not valid scientifically. Recent evidence from chromosomal and transcriptional testing of uveal melanomas suggests that treatment of the primary intraocular tumor seems to have limited if any impact on survival.
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