PURPOSE

To evaluate the prognosis of eyelid sebaceous carcinoma (SeC) in patients with disease stage worse than IIA.

METHODS

This retrospective, single-center study included 78 SeC patients. For stage II patients, 1:3 propensity score matching (PSM) was applied between those undergoing orbital exenteration and those receiving eye-sparing treatments. Risk factors in the eye-sparing group were analyzed using Cox regression, and Kaplan-Meier survival analysis assessed metastasis-free survival (MFS), recurrence-free survival (RFS), disease-specific survival (DSS), and progression-free survival (PFS).

RESULTS

Seventy-eight patients treated at Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, from January 2010 to July 2024, were followed for a median of 40.5 months. Of these, 60 patients (76.9%) had stage II disease, 13 patients (16.7%) had stage III, and five patients (6.4%) had stage IV. After PSM, patients with an advanced clinical T (cT) category (cT4 vs. cT3) or equatorial region involvement were more likely to require orbital exenteration and had poorer MFS following eye-sparing surgery. For stage II patients who died of tumor-related causes, the average survival was 144.3 months. For stage III patients with distant metastasis, survival post-metastasis averaged 12.5 months; for stage IV patients, the time from diagnosis to tumor-specific death averaged 49.0 months.

CONCLUSIONS

In stage II SeC, eye-sparing treatment offered comparable outcomes to orbital exenteration. Orbital exenteration is recommended for tumor involved with the equatorial region. Systemic therapy may be beneficial for patients with distant metastases, although further research is needed to optimize adjuvant treatment.