Julius Peter, Siyumbwa Stepfanie N, Moonga Phyllis, Maate Fred, Kaile Trevor, Kang Guobin, West John T, Wood Charles, Angeletti Peter C
Department of Pathology and Microbiology, School of Medicine, Lusaka, Zambia.
University Teaching Hospital, Eye Hospital, Lusaka, Zambia.
Ocul Oncol Pathol. 2021 Mar;7(2):108-120. doi: 10.1159/000511610. Epub 2021 Jan 21.
This study aimed to characterize the clinical and pathologic presentation of ocular surface tumors (OSTs) and to more precisely differentiate the grades of ocular surface squamous neoplasia (OSSN) and benign lesions among Zambians.
Two-hundred sixty-five Zambian patients presenting with ocular surface growths, suspicious for OSSN, were recruited between November 2017 and November 2019 to a cross-sectional study to investigate their lesions. Sociodemographic data were collected, HIV infection status and vision tests were performed, and lesions were measured and documented. Lesions >2 mm in diameter were excised and sent for pathology analysis. In addition to the biopsies, tears, blood, and buccal swabs were collected. CD4+ T-cell counts were measured by flow cytometry. Lesions were classified according to the WHO guidelines. χ and bivariate correlations were used to analyze variable associations and strengths with phi/Cramer's V and correlation coefficients, respectively. Binary logistics was used to adjust for covariance.
In this study, 68.3% of the participants were found to be HIV positive. The most frequent diagnoses were invasive OSSN (45.3%), preinvasive OSSN (29.1%), and pterygium (22.6%). Invasive OSSN comprised keratinizing squamous cell carcinoma (SCC) (87.5%), basaloid SCC (3.3%), and spindle cell carcinoma (3.3%). Unusual carcinomas, not described previously, included hybrid SCC (5.0%) and acantholytic SCC (0.8%). Invasive OSSN had advanced tumor (T3/T4) staging (93.3%) at diagnosis. Lymphadenopathy was rare (2.3%), and metastasis was absent. Patients were mostly female (59.2%). Median age was 36 (interquartile ranges 33-41) years (ranges 18-81). Patients with invasive OSSN were more likely to present with pain ( = 0.007), redness ( = 0.034), excessive tearing ( = 0.0001), discharge ( = 0.011), bleeding ( = 0.007), reduced vision ( = 0.0001), fungating lesion ( = 0.001), and blindness ( = 0.005); location at temporal limbus ( = 0.0001), inferior limbus ( = 0.0001), or circumlimbal ( = 0.001); and extension to cornea ( = 0.006) and forniceal palpebral conjunctiva ( = 0.001). Invasive OSSN was associated with any smoking habit and alcohol consumption ( = 0.04 and 0.03, respectively). HIV positivity was strongly associated with OSSN (74.6% OSSN vs. 49.3% benign lesions; = 0.0001; phi: 0.237 [ = 0.0001]).
OSTs are very common in Zambia and are strongly associated with HIV coinfection. Patients with OSSN were more likely to be HIV positive than those with pterygia. Despite the commonality of OSTs in sub-Saharan Africa, these cancers have historically been poorly characterized.
本研究旨在描述眼表肿瘤（OSTs）的临床和病理表现，并更准确地区分赞比亚人眼表鳞状上皮肿瘤（OSSN）的分级及良性病变。
2017年11月至2019年11月期间，招募了265例疑似OSSN的赞比亚眼表肿物患者，进行一项横断面研究以调查其病变情况。收集社会人口统计学数据，检测HIV感染状况并进行视力测试，对病变进行测量和记录。直径>2mm的病变切除后送病理分析。除活检外，还收集眼泪、血液和口腔拭子。通过流式细胞术检测CD4 + T细胞计数。病变根据世界卫生组织指南进行分类。分别使用χ检验和双变量相关性分析变量之间的关联及强度，采用phi/Cramer's V和相关系数表示。采用二元逻辑回归调整协变量。
本研究中，68.3%的参与者被发现HIV阳性。最常见的诊断为浸润性OSSN（45.3%）、浸润前OSSN（29.1%）和翼状胬肉（22.6%）。浸润性OSSN包括角化鳞状细胞癌（SCC）（87.5%）、基底样SCC（3.3%）和梭形细胞癌（3.3%）。既往未描述过的罕见癌包括混合性SCC（5.0%）和棘层松解性SCC（0.8%）。浸润性OSSN在诊断时多为晚期肿瘤（T3/T4）分期（93.3%）。淋巴结病罕见（2.3%），无转移。患者多为女性（59.2%）。中位年龄为36岁（四分位间距33 - 41岁）（范围18 - 81岁）。浸润性OSSN患者更易出现疼痛（P = 0.007）、眼红（P = 0.034）、流泪过多（P = 0.0001）、分泌物增多（P = 0.011）、出血（P = 0.007）、视力下降（P = 0.0001）、溃疡样病变（P = 0.001）及失明（P = 0.005）；病变位于颞侧角膜缘（P = 0.0001）、下方角膜缘（P = 0.0001）或角膜缘周围（P = 0.001）；累及角膜（P = 0.006）及穹窿部睑结膜（P = 0.001）。浸润性OSSN与任何吸烟习惯及饮酒相关（分别为P = 0.04和0.03）。HIV阳性与OSSN密切相关（OSSN患者中74.6%为HIV阳性，良性病变患者中49.3%为HIV阳性；P = 0.0001；phi值：0.237 [P = 0.0001]）。
OSTs在赞比亚非常常见，且与HIV合并感染密切相关。OSSN患者比翼状胬肉患者更易HIV阳性。尽管OSTs在撒哈拉以南非洲很常见，但这些癌症在历史上特征描述较少。
