Chauhan Sheetal, Sen Seema, Sharma Anjana, Tandon Radhika, Kashyap Seema, Pushker Neelam, Vanathi Murugesan, Sharma Namrata
From the Department of Ocular Pathology (Ms Chauhan and Drs Sen and Kashyap), Department of Ocular Microbiology (Dr A. Sharma), Cornea and Refractive Surgery Service (Drs Tandon and N. Sharma), Ophthalmoplasty Service (Dr Pushker), and Cornea and Ocular Surface Service (Dr Vanathi), Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.
Arch Pathol Lab Med. 2014 Nov;138(11):1488-94. doi: 10.5858/arpa.2013-0353-OA.
Ocular surface squamous neoplasia (OSSN) is the most common tumor of conjunctival epithelium associated with risk of permanent visual impairment. It includes conjunctival intraepithelial neoplasia and squamous cell carcinoma. Although American Joint Committee on Cancer-TNM (AJCC-TNM) staging is commonly used in various tumors, it has only recently been described for OSSN.
To evaluate the prognostic relevance of AJCC-TNM staging and the clinicopathological features in OSSN.
Sixty-four histopathologically proven cases of OSSN (20 conjunctival intraepithelial neoplasia and 44 squamous cell carcinoma) were included in the study. The AJCC-TNM staging and clinicopathological features of OSSN cases were recorded. Patients were followed up for 17 to 40 months (median, 32 months). Univariate and multivariate analyses were performed to determine the prognostic value of various clinicopathological features.
Longer sunlight exposure (P = .01), diffuse growth pattern (P = .02), larger tumor size (≥2 cm) (P = .03), histopathological diagnosis of squamous cell carcinoma (P = .02), and orbital invasion or invasion of adjacent structures (T3 or T4) (P < .001) emerged as significant predictors of reduced recurrence-free survival. Using multivariate analysis, a higher T category (T3 or T4) was the most important prognostic indicator of a poor outcome.
A higher T category (T3 or T4) is an important predictor of clinical outcome, and the use of the AJCC-TNM staging system is recommended in the management of all patients with OSSN. Longer sunlight exposure, larger tumor size (≥2 cm), orbital invasion or invasion of adjacent structures (T3 or T4), and a histopathological diagnosis of squamous cell carcinoma are other clinicopathological features of prognostic relevance in patients with OSSN.
眼表鳞状上皮肿瘤（OSSN）是结膜上皮最常见的肿瘤，有导致永久性视力损害的风险。它包括结膜上皮内瘤变和鳞状细胞癌。尽管美国癌症联合委员会-肿瘤分期（AJCC-TNM）常用于各种肿瘤，但OSSN的分期最近才被描述。
评估AJCC-TNM分期及OSSN临床病理特征与预后的相关性。
本研究纳入64例经组织病理学证实的OSSN病例（20例结膜上皮内瘤变和44例鳞状细胞癌）。记录OSSN病例的AJCC-TNM分期及临床病理特征。对患者进行了17至40个月（中位时间为32个月）的随访。进行单因素和多因素分析以确定各种临床病理特征的预后价值。
更长的阳光暴露时间（P = 0.01）、弥漫性生长模式（P = 0.02）、更大的肿瘤大小（≥2 cm）（P = 0.03）、鳞状细胞癌的组织病理学诊断（P = 0.02）以及眼眶侵犯或邻近结构侵犯（T3或T4）（P < 0.001）是无复发生存期缩短的显著预测因素。通过多因素分析，更高的T分期（T3或T4）是预后不良的最重要预测指标。
更高的T分期（T3或T4）是临床结局的重要预测指标，建议在所有OSSN患者的管理中使用AJCC-TNM分期系统。更长的阳光暴露时间、更大的肿瘤大小（≥2 cm）、眼眶侵犯或邻近结构侵犯（T3或T4）以及鳞状细胞癌的组织病理学诊断是OSSN患者其他具有预后相关性的临床病理特征。
