Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
Department of Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
EBioMedicine. 2018 Oct;36:221-228. doi: 10.1016/j.ebiom.2018.09.011. Epub 2018 Sep 17.
The prognosis of Chinese patients with eyelid sebaceous carcinoma (SC) has not been updated for >3 decades. The prognostic predictors are multifactorial, and there is no validated prognostic model for eyelid SC.
This study included 238 consecutive patients with eyelid SC. All eligible patients were followed up for metastasis and mortality. The predictors of tumor-related survival were explored by Cox analyses. A prognostic nomogram was developed and validated using bootstrap resampling. The predictive accuracy and discriminative ability were compared between the nomogram and the Tumor, Node, Metastasis (TNM) staging system.
After a median follow-up period of 55.5 months, 27 (11.3%) patients died of metastatic SC, with a median survival time of 48.0 months. The 5-year and 10-year tumor-related survival rates were 88.1% and 77.9%, respectively. Orbital involvement (HR: 3.11, p = .022), the greatest tumor basal diameter (HR: 1.06, p = .003), the presence of pagetoid spread (HR: 2.90, p = .017), and having lymph node metastasis at initial diagnosis (HR: 13.66, p < .001) were independent risk factors for tumor-related death. A nomogram integrating these 4 factors was developed with a C-index of 0.887, which is significantly better than that of the TNM staging system (p = .002). The risk groups stratified by nomogram scores (p < .001 (low vs intermediate risk); p = .001 (intermediate vs high risk)) displayed better discrimination ability than TNM staging (T1 vs T2: p = .358; T2 vs T3: p = .171; T3 vs T4: p < .001) in patients at an early stage.
The prognosis of Chinese patients with eyelid SC has improved over the last 3 decades, and it is comparable to that of patients from other countries. This nomogram provides more accurate individualized estimates of survival for eyelid SC patients and may guide clinicians in their therapeutic decisions.
中国眼睑皮脂癌（SC）患者的预后已有 30 多年未更新。预后预测因素是多因素的，目前尚无眼睑 SC 的验证预后模型。
本研究纳入了 238 例连续的眼睑 SC 患者。所有符合条件的患者均接受了转移和死亡随访。通过 Cox 分析探讨了肿瘤相关生存的预测因素。使用 bootstrap 重采样开发并验证了一个预后列线图。比较了列线图和肿瘤、淋巴结、转移（TNM）分期系统之间的预测准确性和区分能力。
在中位随访 55.5 个月后，27 例（11.3%）患者死于转移性 SC，中位生存时间为 48.0 个月。5 年和 10 年肿瘤相关生存率分别为 88.1%和 77.9%。眼眶受累（HR：3.11，p =.022）、最大肿瘤基底直径（HR：1.06，p =.003）、存在 paget 样扩散（HR：2.90，p =.017）和初诊时存在淋巴结转移（HR：13.66，p <.001）是肿瘤相关死亡的独立危险因素。整合这 4 个因素的列线图具有 0.887 的 C 指数，明显优于 TNM 分期系统（p =.002）。根据列线图评分分层的风险组（p <.001（低与中危组）；p =.001（中与高危组））在早期患者中的区分能力优于 TNM 分期（T1 与 T2：p =.358；T2 与 T3：p =.171；T3 与 T4：p <.001）。
过去 30 年来，中国眼睑 SC 患者的预后有所改善，与其他国家的患者相当。该列线图为眼睑 SC 患者提供了更准确的个体化生存估计，可能有助于指导临床医生的治疗决策。
