TY - JOUR
T1 - Assessment of metastatic disease status at death in 435 patients with large choroidal melanoma in the collaborative ocular melanoma study (coms) coms report no. 15
AU - Willson, J. K V
AU - Albert, D. M.
AU - Diener-West, M.
AU - McCaffrey, L.
AU - Mo, C. S.
AU - Scully, R. E.
AU - Robinson, N.
AU - Zimbric, M.
PY - 2001
Y1 - 2001
N2 - Background: A systematic review and assessment of disease-related mortality as part of standardized prospective patient follow-up and evaluation within a multicenter clinical trial have been lacking in previous studies of choroidal melanoma. Objective: To describe disease status at death in patients with large choroidal melanoma treated and followed up in the Collaborative Ocular Melanoma Study (COMS). Design: Analysis of reviews of patient status at death performed by the COMS Mortality Coding Committee using available clinical and histopathologic information. Setting and Patients: Reviews of deaths as of July 31, 1997, the cutoff date for reporting initial mortality findings. Interventions: Patients were treated by either enucleation preceded by external beam radiotherapy or enucleation only. Main Outcome Measures: Disease status at the time of death and certainty associated with the coding of disease status, sites of metastasis, and availability of autopsy. Results: Of 1003 patients enrolled in the trial, 457 had died; the estimated median survival from time of enrollment was 7.4 years. Disease status at time of death had been reviewed for 435 deaths (95%). The autopsy rate was 6%. A total of 269 patients (62%) had histopathologically confirmed melanoma metastasis at the time of death, and metastasis was suspected in 92 additional patients (21%) on the basis of imaging and tests but without tissue confirmation. The common sties were liver (93%), lung (24%), and bone (16%); multiple sites were identified in 87% of patients with metastasis. The likelihood of 3 or more sites increased more than 4-fold when autopsy results were available. Conclusions: Detailed mortality coding following a standard protocol provides the most accurate reporting to date of disease-related mortality in patients with choroidal melanoma and also identifies difficulties. Guidelines for the evaluation of future patients in clinical studies of choroidal melanoma are suggested.
AB - Background: A systematic review and assessment of disease-related mortality as part of standardized prospective patient follow-up and evaluation within a multicenter clinical trial have been lacking in previous studies of choroidal melanoma. Objective: To describe disease status at death in patients with large choroidal melanoma treated and followed up in the Collaborative Ocular Melanoma Study (COMS). Design: Analysis of reviews of patient status at death performed by the COMS Mortality Coding Committee using available clinical and histopathologic information. Setting and Patients: Reviews of deaths as of July 31, 1997, the cutoff date for reporting initial mortality findings. Interventions: Patients were treated by either enucleation preceded by external beam radiotherapy or enucleation only. Main Outcome Measures: Disease status at the time of death and certainty associated with the coding of disease status, sites of metastasis, and availability of autopsy. Results: Of 1003 patients enrolled in the trial, 457 had died; the estimated median survival from time of enrollment was 7.4 years. Disease status at time of death had been reviewed for 435 deaths (95%). The autopsy rate was 6%. A total of 269 patients (62%) had histopathologically confirmed melanoma metastasis at the time of death, and metastasis was suspected in 92 additional patients (21%) on the basis of imaging and tests but without tissue confirmation. The common sties were liver (93%), lung (24%), and bone (16%); multiple sites were identified in 87% of patients with metastasis. The likelihood of 3 or more sites increased more than 4-fold when autopsy results were available. Conclusions: Detailed mortality coding following a standard protocol provides the most accurate reporting to date of disease-related mortality in patients with choroidal melanoma and also identifies difficulties. Guidelines for the evaluation of future patients in clinical studies of choroidal melanoma are suggested.
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U2 - 10.1001/archopht.119.5.670
DO - 10.1001/archopht.119.5.670
M3 - Article
C2 - 11346394
AN - SCOPUS:0035025251
SN - 0003-9950
VL - 119
SP - 670
EP - 676
JO - Archives of Ophthalmology
JF - Archives of Ophthalmology
IS - 5
ER -