Predictors of ocular surface squamous neoplasia recurrence after excisional surgery

Abstract

Purpose: To identify predictors of ocular surface squamous neoplasm (OSSN) recurrence after operative resection.

Design: Retrospective case series.

Participants: Three hundred eighty-nine consecutive patients who underwent excisional biopsy for OSSN lesions at the Bascom Palmer Eye Institute from January 1, 2001, to September 20, 2010.

Methods: Review of pathology records and patient charts.

Main outcome measures: Identification of factors predictive of OSSN recurrence.

Results: Of 389 excised OSSN lesions, 44 recurred during follow-up. The 1-year recurrence rate was 10% and the 5-year recurrence rate was 21%, with a mean time to recurrence in those with a recurrence of 2.5 years (standard deviation, 3.4). Using the American Joint Committee on Cancer (AJCC) clinical staging system, T3 and T2 lesions portended a higher risk of recurrence compared with T1 (T2/T1 hazard ratio [HR], 2.05 [P = 0.04]; T3/T1 HR, 2.31 [P = 0.07]). In addition, a location characteristic that increased the risk of tumor recurrence was tarsal involvement (AJCC T3 stage lesion; HR, 4.12; P = 0.007). Nasal location was associated with a decreased risk of tumor recurrence (HR, 0.41; P = 0.008). Pathologic characteristics significantly associated with tumor recurrence were the presence of positive margins (HR, 2.73; P = 0.008) and higher grade lesions (carcinoma in situ and squamous cell carcinoma versus dysplasia; HR, 2.55; P = 0.02). Treatment with adjuvant cryotherapy significantly decreased the risk of tumor recurrence (HR, 0.51; P = 0.03). In those patients with positive margins, the use of postoperative topical interferon therapy lowered the recurrence rate to a level similar to that of patients with negative margins.

Conclusions: Certain patient and tumor factors are associated with a higher risk of OSSN recurrence after operative excision, such as tarsal tumor location and positive surgical margins. Postoperative adjuvant therapy should be considered in patients with high-risk OSSN characteristics.

Figure 1

Slit lamp photograph of a multifocal ocular surface squamous neoplasia demonstrating two foci of tumor, one at 6 and one at 9’oclock.

Figure 2

Slit lamp photograph of a papillomatous ocular surface squamous neoplasia demonstrating multiple abnormal blood vessels surrounded by fleshy tissue.

Figure 3

Slit lamp photograph of a leukoplakic ocular surface squamous neoplasia demonstrating a white, keritanized plaque overlying the tumor.

Figure 4

Slit lamp photograph of a gelatinous ocular surface squamous neoplasia demonstrating a smooth, gelatin like appearance.

Figure 5

Slit lamp photograph of a nodular ocular surface squamous neoplasia demonstrating significant elevation.

Figure 6

Kaplan Meier survival curve demonstrating the recurrence rate of ocular surface squamous neoplasia (OSSN) over time.

Figure 7

Kaplan Meier survival curve demonstrating an increased recurrence rate of ocular surface squamous neoplasia (OSSN) in patients with higher clinical stage American Joint Committee on Cancer (AJCC) tumors (T3 and T2 compared to T1).

Figure 8

Kaplan Meier survival curve demonstrating a decreased recurrence rate of ocular surface squamous neoplasia (OSSN) in patients treated with adjuvant cryotherapy.

Figure 9

Kaplan Meier survival curve demonstrating a trend towards a decreased recurrence rate of ocular surface squamous neoplasia (OSSN) in patients with positive pathologic margins who were treated with topical interferon therapy after surgery.