■局部复发预示眼睑皮脂腺癌(SC)预后不良。复发预测因素因研究而异。准确的复发估计对于眼睑SC的个体化治疗至关重要。本研究旨在确定复发预测因子,并开发用于眼睑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例连续的眼睑SC患者进行了图表回顾。所有患者均在初次手术后进行随访。采用多因素Cox回归分析探讨复发的独立预测因子。开发了用于复发预测的列线图,并通过Bootstrap重采样进行了验证。将预测准确性和辨别能力与肿瘤进行比较,节点,转移(TNM)分期系统。
■超过60个月的中位随访时间,167例(40%)患者局部复发。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(危险比[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)和术中冰冻切片控制的Mohs显微手术初始手术(HR=0.53,95%CI=0.35-0.80,P=0.003)是复发的独立影响因素。将这四个因素与pagetoid扩散相结合的列线图显示出令人满意的辨别能力(C指数=0.80-0.83;曲线下面积[AUC]=0.82-0.84),比较优于TNM分期(均P<0.05)。
■眼睑SC的复发率很高。建议早期发现和Mohs显微手术切除以控制复发。眼眶受累的患者,Ki67高表达,和pagetoid传播可能需要辅助措施。这个列线图提供了更准确的复发估计,帮助做出治疗决策。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.