Xu Mingpeng, Chen Qian, Luo Yingxiu, Chai Peiwei, He Xiaoyu, Huang Hengye, Tan Jia, Ye Juan, Zhou Chuandi
Department of Ophthalmology, Xinhua hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Invest Ophthalmol Vis Sci. 2024 Aug 1;65(10):4. doi: 10.1167/iovs.65.10.4.
Local recurrence predicts dismal prognosis in eyelid sebaceous carcinoma (SC). Recurrence predictors vary across studies. Accurate recurrence estimation is essential for individualized therapy in eyelid SC. This study aims to identify recurrence predictors and develop a nomogram for personalized prediction in eyelid SC.
We conducted a multicenter retrospective cohort study. Chart reviews were performed in 418 consecutive patients with eyelid SC. All patients were followed up after their initial surgery. Multivariate Cox regression was used to explore the independent predictors of recurrence. A nomogram for recurrence prediction was developed and validated with bootstrap resampling. The predictive accuracy and discriminative ability were compared with the Tumor, Node, Metastasis (TNM) staging system.
Over a median of 60-month follow-up, 167 patients (40%) had local recurrence. The median time from diagnosis to recurrence was 14 months. The 1-year cumulative recurrence rate was 18%. Diagnostic delay (hazard ratio [HR] = 1.01, 95% confidence interval [CI] = 1.00-1.01, P = 0.001), orbital involvement (HR = 4.47, 95% CI = 3.04-6.58, P < 0.001), Ki67 (HR = 1.01, 95% CI = 1.00-1.02, P = 0.008) and initial surgery of Mohs micrographic surgery with intraoperative frozen section control (HR = 0.53, 95% CI = 0.35-0.80, P = 0.003) were independent influencing factors of recurrence. A nomogram integrating these four factors combined with pagetoid spread displayed satisfactory discriminative ability (C-index = 0.80-0.83; area under the curve [AUC] = 0.82-0.84), which compared favorably than TNM staging (all P < 0.05).
The recurrence rate is high in eyelid SC. Early detection and primary resection with Mohs micrographic surgery are recommended in controlling recurrence. Patients with orbital involvement, high Ki67 expression, and pagetoid spread may require adjuvant measures. This nomogram offers more accurate recurrence estimates, aiding in therapeutic decision making.
局部复发预示眼睑皮脂腺癌（SC）预后不良。不同研究中的复发预测因素各不相同。准确估计复发情况对于眼睑SC的个体化治疗至关重要。本研究旨在确定复发预测因素，并开发一种用于眼睑SC个性化预测的列线图。
我们进行了一项多中心回顾性队列研究。对418例连续性眼睑SC患者进行病历审查。所有患者在首次手术后均接受随访。采用多变量Cox回归分析来探索复发的独立预测因素。通过自抽样重采样开发并验证了复发预测列线图。将预测准确性和判别能力与肿瘤、淋巴结、转移（TNM）分期系统进行比较。
在中位60个月的随访期内，167例患者（40%）出现局部复发。从诊断到复发的中位时间为14个月。1年累积复发率为18%。诊断延迟（风险比[HR]=1.01，95%置信区间[CI]=1.00 - 1.01，P = 0.001）、眼眶受累（HR = 4.47，95%CI = 3.04 - 6.58，P < 0.001）、Ki67（HR = 1.01，95%CI = 1.00 - 1.02，P = 0.008）以及采用术中冰冻切片控制的Mohs显微外科手术作为初始手术方式（HR = 0.53，95%CI = 0.35 - 0.80，P = 0.003）是复发的独立影响因素。整合这四个因素并结合派杰样扩散的列线图显示出令人满意的判别能力（C指数 = 0.80 - 0.83；曲线下面积[AUC]=0.82 - 0.84），优于TNM分期（所有P < 0.05）。
眼睑SC的复发率较高。建议早期检测并采用Mohs显微外科手术进行原发灶切除以控制复发。眼眶受累、Ki67高表达和派杰样扩散的患者可能需要辅助治疗措施。该列线图可提供更准确的复发估计，有助于治疗决策。
