Ocular Pathology Services, Dr.Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Science (SGPGIMS), Lucknow, Uttar Pradesh, India.
Acta Ophthalmol. 2023 Feb;101(1):49-56. doi: 10.1111/aos.15204. Epub 2022 Jun 24.
This study compares the 8th edition staging of AJCC for prognosis of eyelid Sebaceous Gland Carcinoma (SGC) patients with respect to the 7th edition.
A retrospective study was undertaken over a period of 100 months. Ninety-nine histopathologically proven cases of eyelid SGC available for follow-up were recruited. Patients were staged by both the 7th and 8th editions of AJCC and followed up at six monthly intervals after surgery.
Of the 99 eyelid SGC patients recruited, recurrence and orbital invasion developed in 22%, lymph node metastasis in 21% and 4% had distant metastasis and also died. High-risk features include tumour size>20 mm, orbital invasion, exenteration and staging by both the 7th and 8th editions of AJCC. Cox regression analysis revealed that staging by AJCC 8th edition was associated with greater risk for local recurrence (HR 3.01,95% CI-1.65-5.51%, p < 0.01) lymph node metastasis (HR 8.26, 95% CI 3.96-17.19%, p < 0.01) and disease-free survival (HR 4.61, 95% CI 2.81-7.54). The Kaplan-Meir survival curves of eyelid SGC patients by the 8th edition AJCC staging were also significantly associated with lymph node metastasis (p < 0.01), tumour-related deaths (p < 0.01) and reduced disease-free survival (p = 0.07). The higher Harrell's values by the 8th edition signify better predictive value for lymph node metastasis and DFS (disease-free survival). The lower AIC values indicate a better monotonicity of gradients for lymph node metastasis, recurrence and DFS.
Staging by the 8th AJCC edition is, therefore, recommended for eyelid SGC as it gives a better perspective about disease outcome. The orbital extension was the single most important predictor of lymph node metastasis, recurrence and death.
本研究比较了 AJCC 第 8 版与第 7 版在预测眼睑皮脂腺癌 (SGC) 患者预后方面的差异。
本研究采用回顾性研究方法，对 100 个月内的 99 例经组织病理学证实的眼睑 SGC 患者进行了研究。这些患者都可进行随访，所有患者均按第 7 版和第 8 版 AJCC 分期，术后每 6 个月随访一次。
99 例眼睑 SGC 患者中，22%出现复发和眼眶侵犯，21%出现淋巴结转移，4%出现远处转移并死亡。高危特征包括肿瘤大小>20mm、眼眶侵犯、眶内容剜除术以及第 7 版和第 8 版 AJCC 分期。Cox 回归分析显示，AJCC 第 8 版分期与局部复发风险增加相关（HR 3.01，95%CI-1.65-5.51%，p<0.01）、淋巴结转移风险增加（HR 8.26，95%CI 3.96-17.19%，p<0.01）和无病生存率降低（HR 4.61，95%CI 2.81-7.54%）相关。根据 AJCC 第 8 版分期的眼睑 SGC 患者 Kaplan-Meier 生存曲线也与淋巴结转移（p<0.01）、肿瘤相关死亡（p<0.01）和无病生存率降低（p=0.07）显著相关。第 8 版 AJCC 分期的 Harrell 更高值表明对淋巴结转移和 DFS（无病生存率）有更好的预测价值。较低的 AIC 值表明淋巴结转移、复发和 DFS 的梯度更单调。
因此，建议对眼睑 SGC 采用第 8 版 AJCC 分期，因为它能更好地预测疾病结局。眼眶侵犯是淋巴结转移、复发和死亡的唯一最重要的预测因素。
