Ford Joshua, Thakar Sudip, Thuro Bradley, Esmaeli Bita
*Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, and †Department of Ophthalmology, Tulane University, New Orleans, Louisiana, U.S.A.
Ophthalmic Plast Reconstr Surg. 2017 Sep/Oct;33(5):317-324. doi: 10.1097/IOP.0000000000000901.
To determine the prognostic value of the staging criteria for eyelid tumors in the 7th edition of the American Joint Committee on Cancer (AJCC) staging manual and to determine, for each type of eyelid tumor, which AJCC T categories are associated with increased risk of nodal metastasis and thus potential usefulness of sentinel lymph node biopsy.
Systematic review and analysis of articles found by searching PubMed and Google Scholar using the search terms "AJCC," "eyelid," "carcinoma," and "melanoma."
Rates of local recurrence, regional nodal metastasis, and distant metastasis were approximately 7% to 10%, 1% to 9%, and 0% to 0.8%, respectively, for eyelid squamous cell carcinoma; 5% to 6%, 8% to 23%, and 2% and 14%, respectively, for eyelid sebaceous carcinoma; 10%, 10% to 22%, and 19% to 22%, respectively, for eyelid Merkel cell carcinoma (when staged according to the criteria for eyelid carcinoma as opposed to Merkel cell carcinoma), 14%, 5%, and 0%, respectively, for eyelid sweat gland carcinoma; and 2%, 9%, and 6%, respectively, for eyelid melanoma. Overall, the risks of local recurrence and regional nodal and distant metastasis appeared to increase with increasing AJCC T category, although not statistically significant in all studies. Clinical T2b or greater T category was significantly associated with increased risk of nodal metastasis for eyelid squamous cell carcinomas, sebaceous carcinomas, Merkel cell carcinomas (staged with eyelid carcinoma criteria), sweat gland carcinomas, and melanomas. Clinical T3 or greater T category was significantly associated with distant metastasis for eyelid carcinomas and melanomas.
For eyelid carcinomas and eyelid melanomas, AJCC 7th edition T category correlates with the risks of nodal and distant metastasis, with T2b and larger tumors associated with highest risk of nodal metastasis. Patients with T2b or larger tumors may be candidates for sentinel lymph node biopsy or close nodal surveillance.
确定美国癌症联合委员会（AJCC）第7版分期手册中眼睑肿瘤分期标准的预后价值，并针对每种类型的眼睑肿瘤，确定哪些AJCC T类别与区域淋巴结转移风险增加相关，从而确定前哨淋巴结活检的潜在实用性。
通过使用搜索词“AJCC”、“眼睑”、“癌”和“黑色素瘤”在PubMed和谷歌学术上搜索，对找到的文章进行系统回顾和分析。
眼睑鳞状细胞癌的局部复发率、区域淋巴结转移率和远处转移率分别约为7%至10%、1%至9%和0%至0.8%；眼睑皮脂腺癌分别为5%至6%、8%至23%和2%至14%；眼睑默克尔细胞癌（按照眼睑癌标准而非默克尔细胞癌标准分期时）分别为10%、10%至22%和19%至22%；眼睑汗腺癌分别为14%、5%和0%；眼睑黑色素瘤分别为2%、9%和6%。总体而言，尽管并非在所有研究中都具有统计学意义，但随着AJCC T类别的增加，局部复发、区域淋巴结和远处转移的风险似乎也在增加。临床T2b或更高的T类别与眼睑鳞状细胞癌、皮脂腺癌、默克尔细胞癌（按照眼睑癌标准分期）、汗腺癌和黑色素瘤的区域淋巴结转移风险增加显著相关。临床T3或更高的T类别与眼睑癌和黑色素瘤的远处转移显著相关。
对于眼睑癌和眼睑黑色素瘤，AJCC第7版T类别与区域淋巴结和远处转移风险相关，T2b及更大的肿瘤与区域淋巴结转移风险最高相关。T2b或更大肿瘤的患者可能是前哨淋巴结活检或密切淋巴结监测的候选者。
