Abstract：
OBJECTIVE: To analyze the presentation and outcomes of eyelid and periocular sebaceous gland carcinoma (SGC) based on prognostic stage of the 8th edition of American Joint Committee on Cancer (AJCC) classification.
METHODS: Retrospective clinical cohort study METHODS: • Setting: Quaternary referral center • Study population: 500 eyes of 499 patients with SGC • Intervention: Excisional biopsy, chemotherapy, Orbital exenteration • Main outcome measures: Tumor recurrence, lymph node metastasis, systemic metastasis, and death based on AJCC prognostic staging RESULTS: The mean age at presentation with SGC was 57 years (55 years; range, 26 to 82 years). Based on the 8th edition of AJCC classification, tumors belonged to Stage 0 (n=13, 3%), I (n=158, 32%), II (n=269, 54%), III (n=48, 9%), and IV (n=12, 2%). At a mean follow-up of 26 months (median, 10 months; range, <1 to 192 months), tumor recurrence, lymph node metastasis, systemic metastasis, and disease-related death were seen in 39 (10%), 65 (16%), 33 (8%), and 33 (8%) patients respectively. Tumor recurrence rates did not differ significantly between the stages (p=0.472). The 5-year Kaplan-Meier estimates of regional lymph node metastasis, systemic metastasis, and metastasis-related death were higher for stage II (12%, 11%, and 12%, respectively), III (69%, 25%, and 42%, respectively) and IV (70%, 100%, and 100%, respectively) compared to stage I (0%, 6%, and 6%, respectively). Cox proportional analysis revealed a greater hazard ratio (HR) for lymph node metastasis in stage II (HR, 3.498; 95% CI, 0.200 to 10.200; p<0.022), III (HR, 95% CI, 24.836; 8.733 to 70.631; p<0.001), and IV (HR, 53.731; 95% CI, 15.418 to 187.253; p<0.001), systemic metastasis in stage III (HR. 13.895; 95% CI, 3.871 to 49.874; p<0.001) and IV (HR, 81.465; 95% CI, 22.267 to 298.051; p<0.001) and for disease-related death in stage III (HR, 9.182; 95% CI, 2.743 to 30.728; p<0.001) and IV (HR, 85.237; 95% CI, 25.331 to 287.422; p<0.001), compared to stage I.
CONCLUSIONS: The prognostic staging of the 8th edition AJCC classification predicts the prognosis of patients with eyelid and periocular SGC, which worsens with the advancing stage. The high incidence of lymph node and systemic metastasis accounts for mortality in these patients.
METHODS: Retrospective clinical cohort study METHODS: • Setting: Quaternary referral center • Study population: 500 eyes of 499 patients with SGC • Intervention: Excisional biopsy, chemotherapy, Orbital exenteration • Main outcome measures: Tumor recurrence, lymph node metastasis, systemic metastasis, and death based on AJCC prognostic staging RESULTS: The mean age at presentation with SGC was 57 years (55 years; range, 26 to 82 years). Based on the 8th edition of AJCC classification, tumors belonged to Stage 0 (n=13, 3%), I (n=158, 32%), II (n=269, 54%), III (n=48, 9%), and IV (n=12, 2%). At a mean follow-up of 26 months (median, 10 months; range, <1 to 192 months), tumor recurrence, lymph node metastasis, systemic metastasis, and disease-related death were seen in 39 (10%), 65 (16%), 33 (8%), and 33 (8%) patients respectively. Tumor recurrence rates did not differ significantly between the stages (p=0.472). The 5-year Kaplan-Meier estimates of regional lymph node metastasis, systemic metastasis, and metastasis-related death were higher for stage II (12%, 11%, and 12%, respectively), III (69%, 25%, and 42%, respectively) and IV (70%, 100%, and 100%, respectively) compared to stage I (0%, 6%, and 6%, respectively). Cox proportional analysis revealed a greater hazard ratio (HR) for lymph node metastasis in stage II (HR, 3.498; 95% CI, 0.200 to 10.200; p<0.022), III (HR, 95% CI, 24.836; 8.733 to 70.631; p<0.001), and IV (HR, 53.731; 95% CI, 15.418 to 187.253; p<0.001), systemic metastasis in stage III (HR. 13.895; 95% CI, 3.871 to 49.874; p<0.001) and IV (HR, 81.465; 95% CI, 22.267 to 298.051; p<0.001) and for disease-related death in stage III (HR, 9.182; 95% CI, 2.743 to 30.728; p<0.001) and IV (HR, 85.237; 95% CI, 25.331 to 287.422; p<0.001), compared to stage I.
CONCLUSIONS: The prognostic staging of the 8th edition AJCC classification predicts the prognosis of patients with eyelid and periocular SGC, which worsens with the advancing stage. The high incidence of lymph node and systemic metastasis accounts for mortality in these patients.
摘要：
目的：根据第8版美国癌症联合委员会（AJCC）分类的预后分期，分析眼睑和眼周皮脂腺癌（SGC）的表现和预后。
方法：回顾性临床队列研究方法：•设置：第四纪转诊中心•研究人群：499例SGC患者的500只眼•干预：切除活检，化疗,•主要结果指标:肿瘤复发,淋巴结转移,全身转移，和基于AJCC预后分期的死亡结果：SGC的平均年龄为57岁（55岁；范围，26至82岁）。根据AJCC第8版分类，肿瘤属于0期（n=13，3%），I(n=158，32%)，II（n=269，54%），III（n=48，9%），和IV（n=12，2%）。平均随访26个月(中位数，10个月；范围，<1至192个月），肿瘤复发,淋巴结转移,全身转移，39例（10%）与疾病相关的死亡，65（16%），33（8%），33例（8%）。肿瘤复发率在各个阶段之间没有显着差异（p=0.472）。区域淋巴结转移的5年Kaplan-Meier估计，全身转移，II期转移相关死亡较高（12%，11%,12%,分别)，III（69%，25%,42%,分别)和IV(70%，100%,100%,分别)与第一阶段(0%，6%,6%,分别)。Cox比例分析显示II期淋巴结转移的风险比（HR，3.498；95%CI，0.200至10.200；p<0.022)，III(HR,95%CI，24.836；8.733至70.631；p<0.001），和IV(HR，53.731；95%CI，15.418至187.253；p<0.001），III期的全身转移（HR。13.895；95%CI，3.871至49.874；p<0.001）和IV（HR，81.465；95%CI，22.267至298.051；p<0.001）和III期疾病相关死亡（HR，9.182；95%CI，2.743至30.728；p<0.001）和IV（HR，85.237；95%CI，25.331至287.422；p<0.001），
结论：第8版AJCC分类的预后分期可预测眼睑和眼周SGC患者的预后，随着阶段的推进而恶化。淋巴结和全身转移的高发生率是这些患者死亡的原因。
方法：回顾性临床队列研究方法：•设置：第四纪转诊中心•研究人群：499例SGC患者的500只眼•干预：切除活检，化疗,•主要结果指标:肿瘤复发,淋巴结转移,全身转移，和基于AJCC预后分期的死亡结果：SGC的平均年龄为57岁（55岁；范围，26至82岁）。根据AJCC第8版分类，肿瘤属于0期（n=13，3%），I(n=158，32%)，II（n=269，54%），III（n=48，9%），和IV（n=12，2%）。平均随访26个月(中位数，10个月；范围，<1至192个月），肿瘤复发,淋巴结转移,全身转移，39例（10%）与疾病相关的死亡，65（16%），33（8%），33例（8%）。肿瘤复发率在各个阶段之间没有显着差异（p=0.472）。区域淋巴结转移的5年Kaplan-Meier估计，全身转移，II期转移相关死亡较高（12%，11%,12%,分别)，III（69%，25%,42%,分别)和IV(70%，100%,100%,分别)与第一阶段(0%，6%,6%,分别)。Cox比例分析显示II期淋巴结转移的风险比（HR，3.498；95%CI，0.200至10.200；p<0.022)，III(HR,95%CI，24.836；8.733至70.631；p<0.001），和IV(HR，53.731；95%CI，15.418至187.253；p<0.001），III期的全身转移（HR。13.895；95%CI，3.871至49.874；p<0.001）和IV（HR，81.465；95%CI，22.267至298.051；p<0.001）和III期疾病相关死亡（HR，9.182；95%CI，2.743至30.728；p<0.001）和IV（HR，85.237；95%CI，25.331至287.422；p<0.001），
结论：第8版AJCC分类的预后分期可预测眼睑和眼周SGC患者的预后，随着阶段的推进而恶化。淋巴结和全身转移的高发生率是这些患者死亡的原因。
