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. 2019 May 1;137(5):537-542.
doi: 10.1001/jamaophthalmol.2019.0238.

Validation Study of the AJCC Cancer Staging Manual, Eighth Edition, Staging System for Eyelid and Periocular Squamous Cell Carcinoma

Shiqiong Xu  1   2 , Oded Sagiv  1 , Maria Laura Rubin  3 , Ho-Seok Sa  1   4 , Michael T Tetzlaff  5 , Priyadharsini Nagarajan  5 , Jing Ning  3 , Bita Esmaeli  1
Affiliations

Validation Study of the AJCC Cancer Staging Manual, Eighth Edition, Staging System for Eyelid and Periocular Squamous Cell Carcinoma

Shiqiong Xu et al. JAMA Ophthalmol. .

Erratum in

  • Error in Byline.
    [No authors listed] [No authors listed] JAMA Ophthalmol. 2019 May 1;137(5):587. doi: 10.1001/jamaophthalmol.2019.1191. JAMA Ophthalmol. 2019. PMID: 31070682 Free PMC article. No abstract available.

Abstract

Importance: To our knowledge, there are no validation studies to date of the prognostic value of the AJCC Cancer Staging Manual, eighth edition (AJCC 8), criteria for eyelid and periocular squamous cell carcinoma.

Objective: To determine the association of tumor (T) category in AJCC 8 with local recurrence, nodal metastasis, distant metastasis, and disease-specific survival (DSS) for eyelid and periocular squamous cell carcinoma.

Design, setting, and participants: In this retrospective, single-center cohort study, 109 consecutive patients with eyelid and periocular squamous cell carcinoma treated from January 1999 to April 2018 were included. Patients with secondary involvement of the periocular region were excluded.

Main outcomes and measures: Local recurrence, nodal metastasis, distance metastasis, and DSS.

Results: Of the 109 included patients, 81 (74.3%) were male, and the median (range) age was 66 (40-91) years. At presentation, 43 patients (39.4%) had recurrent tumor, 4 (3.7%) had nodal metastasis, and 1 (0.9%) had distant metastasis. The median (range) follow-up was 23 (1-161) months. During follow-up, 11 patients (10.1%) developed local recurrence, 7 (6.4%) developed nodal metastasis, 2 (1.8%) developed distant metastasis, and 9 (8.3%) died of disease. The 5-year DSS rate was 87.7% (95% CI, 79.5-96.9). Chronic immunosuppression (hazard ratio, 47.24; 95% CI, 7.33-304.30; P < .001) and presentation with recurrent squamous cell carcinoma (hazard ratio, 5.22; 95% CI, 1.12-24.31; P = .04) were associated with local recurrence during follow-up. Of the 11 patients with local recurrence during follow-up, 7 (64%) had perineural invasion. T category was associated with nodal metastasis; clinical stage of T2c or worse at presentation was associated with higher risk of nodal metastasis and death of disease but not with a higher risk of local recurrence. Distant metastasis was associated with nodal metastasis at presentation (hazard ratio, 32.50; 95% CI, 1.97-536.40; P = .02) and during follow-up. A total of 33 patients (30.3%) had different T categories depending on whether disease was staged according to the seventh or eighth edition of the AJCC Cancer Staging Manual. Compared with AJCC 7, AJCC 8 showed a better predictive value in terms of local recurrence (T3, 17% vs 14%; T4, 11% vs 16%) and DSS.

Conclusions and relevance: These findings suggest that T category in AJCC 8 is associated with nodal metastasis and DSS. Immunosuppression and presentation with recurrent disease are associated with increased risk of future local recurrence. Patients with tumors of clinical stage T2c or worse at presentation are at increased risk of nodal metastasis and worse DSS and should undergo surveillance for nodal metastasis. Future studies, ideally prospective in design, could provide greater confidence in these findings.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Tetzlaff has received personal fees from Myriad Genetics, Novartis, and Seattle Genetics. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Survival Curve for Local Recurrence of Periocular Squamous Cell Carcinoma by Primary vs Recurrent Tumor at Presentation
Tumor category was determined by AJCC Cancer Staging Manual, eighth edition.
Figure 2.
Figure 2.. Kaplan-Meier Survival Curve for Local Recurrence of Periocular Squamous Cell Carcinoma by Immune Status
Tumor category was determined by AJCC Cancer Staging Manual, eighth edition.
Figure 3.
Figure 3.. Kaplan-Meier Survival Curve for Distant Metastasis in Patients With Periocular Squamous Cell Carcinoma by Presence of Nodal Metastasis at Presentation
Tumor category was determined by AJCC Cancer Staging Manual, eighth edition.
Figure 4.
Figure 4.. Kaplan-Meier Curve by Tumor (T) Category for Local Recurrence
T category was determined by AJCC Cancer Staging Manual, eighth edition.
See this image and copyright information in PMC

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