A systematic review and meta-analysis of enucleation versus pre-enucleation radiotherapy in choroidal melanoma...

To use a literature review methodology to assess the efficacy of three distinct approaches: enucleation, radiotherapy or radiotherapy prior to enucleation, in reducing patient mortality.

Computers were used to search databases such as PubMed, Web of Science, Embase, Cochrane Library, and CNKI, as well as the references of pertinent literature. Data were extracted from the included research literature according to the pre-defined data extraction table, encompassing study characteristics, sample size, interventions, outcome measures, etc. The Cochrane risk of bias evaluation instrument was employed to assess the excellence of encompassed researches, and the RevMan software was utilized for conducting the meta-analysis.

10 final articles were included, with 3 studies among them presenting the overall mortality rate at five-year follow-up. The homogeneity trial (P = 0.02, I² = 75%) showed remarkable heterogeneity, leading to the adoption of a random-effects model. The meta-analysis findings unveiled a distinction in the total mortality rate between the two groups (RR = 0.98, 95%CI was 0.81 ~ 1.18, P < 0.01). Five of the included studies reported mortality due to tumor metastasis during five-year follow-up. The homogeneity test (P = 0.03, I² = 64%) showed the presence of heterogeneity, leading to the utilization of a random effects model. The meta-analysis results revealed a remarkable disparity in mortality due to tumor metastasis between the two groups (RR = 0.88, 95%CI was 0.70 ~ 1.10, P < 0.01). Five of the included studies reported total mortality during a ten-year follow-up period. The homogeneity test (P = 0.99, I ² = 0%) demonstrated no heterogeneity, necessitating the adoption of a fixed model. The meta-analysis revealed no statistically significant difference in total mortality between the two groups (RR = 1.04, 95%CI = 0.92-1.17, P = 0.55). Four of the included studies reported mortality due to tumor metastasis at ten-year follow-up. The homogeneity trial (P = 0.41, I² = 0%) showed the absence of heterogeneity, prompting the application of a fixed effects model. The meta-analysis demonstrated no statistically significant difference in mortality due to tumor metastasis between the two groups (RR = 0.84, 95%CI = 0.67-1.05, P = 0.12).

There are disparities in the five-year overall mortality and mortality caused by tumor metastasis between enucleation and radiotherapy for CM. When selecting clinical treatment options, the patient's condition, age, physical condition and personal preferences should be comprehensively taken into consideration, along with other factors, to determine the most appropriate treatment strategy.