A REVIEW OF MORTALITY FROM CHOROIDAL MELANOMA .2. A METAANALYSIS OF 5-YEAR MORTALITY-RATES FOLLOWING ENUCLEATION, 1966 THROUGH 1988

With the use of data published during the period from 1966 through 1988, a pooled analysis (meta-analysis) of 5-year mortality rates among patients who had an eye enucleated for choroidal melanoma was performed to provide a more robust estimate of this rate than could be obtained from any single study. The literature concerning mortality following a diagnosis of choroidal melanoma has been reviewed systematically and described in a separate article. Of 76 reports published from 1966 through 1988, 29 were excluded from the meta-analysis because there were no cases treated by enucleation alone, mortality was not reported by time from enucleation, fewer than 10 cases were reported, or 5-year mortality rates were not reported or derivable from the data presented. Ten additional reports were excluded because they were based on data for the same set of patients as another article in the series. Of the remaining 37 reports, 29 contained data for patients with tumors of varying sizes that could not be separated into subgroups based on the size of the tumor at the time of treatment. The remaining eight articles reported 5-year mortality rates by tumor size, specifically for small, medium, or large tumors. The combined weighted estimates of 5-year mortality rates following enucleation were 16% for small tumors (95% confidence interval [Cl]: [14%, 18%]), 32% for medium tumors (95% Cl: [29%, 34%]), and 53% for large tumors (95% Cl: [50%, 56%]). Different methods of pooling the data yielded consistent estimates for all three tumor size categories. These results supported the finding by other investigators that tumor size at time of enucleation is a major prognostic factor for patients who have choroidal melanoma.