Sebaceous Carcinoma Of Eyelid Research Articles

Establishment and Characterization of a TP53-Mutated Eyelid Sebaceous Carcinoma Cell Line

Establishment and Characterization of a <i>TP53</i>-Mutated Eyelid Sebaceous Carcinoma Cell Line

Integrated Whole-Exome and Transcriptome Sequencing Indicated Dysregulation of Cholesterol Metabolism in Eyelid Sebaceous Gland Carcinoma.

To identify the molecular background of eyelid sebaceous gland carcinomas (SCs), we conducted the integrated whole-exome sequencing and transcriptome sequencing for eyelid SCs in this study. The genetic alterations were studied by whole-exome sequencing, and the messenger RNA expression was studied using Oxford Nanopore Technologies (ONT) in five paired fresh eyelid SC tissues and adjacent normal tissues. Integrated analysis of exome and transcriptomic information was conducted for filtering candidate driver genes. Protein-protein interaction (PPI) network of filtered candidate genes was analyzed by STRING. The protein expression was verified by immunohistochemistry in 29 eyelid SCs and 17 compared normal sebaceous gland tissues. The average numbers of pathogenic somatic single-nucleotide variants (SNVs) and indels in eyelid SCs were 75 and 28, respectively. Tumor protein p53 (TP53), zinc finger protein 750 (ZNF750), filaggrin 2 (FLG2), valosin-containing protein (VCP), and zinc finger protein 717 (ZNF717) were recurrent mutated genes. A mean of 844 differentially expressed genes (DEGs) were upregulated, and 1401 DEGs were downregulated in SC samples. The intersection of DEG-based pathways and mutation-based pathways was mainly involved in microbial infection and inflammation, immunodeficiency, cancer, lipid metabolism, and the other pathways. The intersection of DEGs and mutated genes consisted of 55 genes, of which 15 genes formed a PPI network with 4 clusters. The PPI cluster composed of scavenger receptor class B member 1 (SCARB1), peroxisome proliferator-activated receptor γ (PPARG), peroxisome proliferator-activated receptor γ coactivator 1α (PPARGC1A) was involved in cholesterol metabolism. The expression of SCARB1 protein was found to be increased, whereas that of PPARG protein was decreased in eyelid SCs compared to that in the normal sebaceous glands. Increased SCARB1 and decreased PPARG indicated that dysregulation of cholesterol metabolism might be involved in carcinogenesis of eyelid SCs. The malfunction in cholesterol metabolism might advance our knowledge of the carcinogenesis of eyelid SCs.

Deep learning-based fully automated differential diagnosis of eyelid basal cell and sebaceous carcinoma using whole slide images.

BackgroundThe differential diagnosis of eyelid basal cell carcinoma (BCC) and sebaceous carcinoma (SC) is highly dependent on pathologist’s experience. Herein, we proposed a fully automated differential diagnostic method, which used deep learning (DL) to accurately classify eyelid BCC and SC based on whole slide images (WSIs).MethodsWe used 116 haematoxylin and eosin (H&E)-stained sections from 116 eyelid BCC patients and 180 H&E-stained sections from 129 eyelid SC patients treated at the Shanghai Ninth People’s Hospital from 2017 to 2019. The method comprises two stages: patch prediction by the DenseNet-161 architecture-based DL model and WSI differentiation by an average-probability strategy-based integration module, and its differential performance was assessed by the carcinoma differentiation accuracy and F1 score. We compared the classification performance of the method with that of three pathologists, two junior and one senior. To validate the auxiliary value of the method, we compared the pathologists’ BCC and SC classification with and without the assistance of our proposed method.ResultsOur proposed method achieved an accuracy of 0.983, significantly higher than that of the three pathologists (0.644 and 0.729 for the two junior pathologists and 0.831 for the senior pathologist). With the method’s assistance, the pathologists’ accuracy increased significantly (P<0.05), by 28.8% and 15.2%, respectively, for the two junior pathologists and by 11.8% for the senior pathologist.ConclusionsOur proposed method accurately classifies eyelid BCC and SC and effectively improves the diagnostic accuracy of pathologists. It may therefore facilitate the development of appropriate and timely therapeutic plans.

Impaired Wnt/beta-catenin and protein patched homolog 1 signaling in extraocular sebaceous carcinoma: A clinical and histopathological study.

Sebaceous carcinoma (SC) is a rare malignant neoplasm with sebaceous differentiation. SC is classified into eyelid and extraocular SC clinically. Most studies have focused on the eyelid SC in terms of pathogenesis, treatment, and prognosis. In skin, Wnt/beta-catenin and hedgehog signaling are two major pathways in sebaceous differentiation. We aimed to characterize the clinical and histopathological features of extraocular SC and to measure the expression of beta-catenin, lymphoid enhancer-binding factor 1 (LEF1), sonic hedgehog (Shh), and protein patched homolog 1 (PTCH) in extraocular SC. Ten cases of extraocular SC were identified from 2007 to 2020. The clinical features, microscopic findings, and prognosis were analyzed. Immunohistochemical stain for beta-catenin, LEF1, Shh, and PTCH were performed in extraocular SC and other benign sebaceous tumors including sebaceous hyperplasia, sebaceous adenoma, and sebaceoma. The male:female ratio was 4:6. The median onset age was 73.5years (range, 43-88). Seven patients out of 10 were diagnosed after 60years. Most extraocular SC were located on the head and neck with indurated plaque. Two patients had concurrent internal cancers and three patients showed lymph node metastasis at time of presentation. Five-year overall-survival was 40%. Beta-catenin was expressed membranously in all sebaceous hyperplasia, but was expressed variably in extraocular SC (1/5). While LEF1 was unequivocally expressed in normal hair follicles, LEF1 expression was absent in all extraocular SC and benign sebaceous tumors. Regarding the sonic hedgehog signaling, Shh and PTCH were all expressed in the cytoplasm of sebaceous hyperplasia, sebaceous adenoma, and sebaceoma. In contrast, PTCH was absent in all cases of extraocular SC and only 50% of the extraocular SC expressed cytoplasmic Shh. To conclude, extraocular SC commonly affects facial skin in the elderly. Inactivated Wnt/beta-catenin and aberrant hedgehog pathway may contribute to the carcinogenesis of extraocular SC. Further studies may be required to elucidate the causative mechanism of these pathways in extraocular SC.

Diffuse pattern, orbital invasion, perineural invasion and Ki-67 are associated with nodal metastasis in patients with eyelid sebaceous carcinoma

BackgroundMetastasis dominates the prognosis of eyelid sebaceous carcinoma (SC). This study aimed to explore risk factors for nodal metastasis and develop a nomogram to predict nodal metastasis in patients with...

Intraepithelial growth pattern for eyelid sebaceous carcinoma: a cohort of 214 patients from a single institution

AimsTo determine the distribution of three different intraepithelial growth patterns (pagetoid, bowenoid and papillary) in eyelid sebaceous carcinoma (SC) and correlate them with the clinical characteristics and prognosis.MethodsA retrospective cohort...

Clinicopathological Analysis andDemographic Features of Ocular Malignancies.

ObjectiveThis study aimed to evaluate the epidemiological and clinicopathological spectrum of ocular malignancies among patients presenting to a teaching hospital in Northern India.MethodsA total of 246 histopathologically diagnosed patients with ocular malignancies were included in the study. Tumor type and size, primary origin and location of tumor, clinical staging, radiological findings, histopathological type, and treatment outcomes were assessed.ResultsOverall, males over 55 years of age were most commonly affected and the majority of cases were primary ocular or adnexal malignancies (n = 226; 91.87%). The eyelids and periocular structures (n = 92; 37.40%) were the most commonly involved site, followed by the orbit (n = 72; 29.27%), ocular surface (n = 46; 18.70%) and intraocular region (n = 36; 14.63%). The majority of the patients (n = 68; 27.64%) were managed by primary surgical excision and reconstruction. However, 46 patients (18.70%) with advanced lesions underwent neoadjuvant chemotherapy followed by surgical excision and more extensive orbital lesions were treated by exenteration followed by adjuvant chemotherapy (n=48; 19.51%), while patients with metastatic tumor were given palliative chemotherapy/external beam radiation therapy (n= 46; 18.70%). Overall, 45.12% of patients were cured completely, 15.45% showed a partial response to the treatment, 13.04% had progressive disease and 16.67% demonstrated disease recurrence.ConclusionA clinicopathological analysis of ocular malignancies at a teaching hospital in Northern India indicated the preponderance of primary ocular malignancies, with eyelid sebaceous gland carcinomas being the most common pathological diagnosis. Most of our patients had advanced and extensive disease among them majority belonged to the rural background and poor socio-economic status.

A case of sebaceous carcinoma in the eyelid: The results of chemoradiotherapy after recurrence

Sebaceous carcinoma of the eyelid, a rare and locally aggressive malignant neoplasm, can metastasize via the lymphatic and hematogenous route. The diagnosis and treatment can be delayed because of the similarity of the tumors with benign lesions. We herein present a 65-year-old male patient who was diagnosed with sebaceous carcinoma of the left upper eyelid 7 years ago, after which surgical resection was performed. Regional recurrence developed in left cervical nodes two years later. Left neck dissection was performed and adjuvant radiotherapy was administered. The patient has no evidence of recurrence or metastasis after radiotherapy during 5 years of follow-up.

Nordic treatment practices survey and consensus for treatment of eyelid sebaceous carcinoma

BackgroundThe purpose was to describe the Nordic treatment practices and to reach a Nordic consensus for the treatment of sebaceous eyelid carcinoma.MethodsThe treatment practices data was collected by a questionnaire with 37 questions to the Nordic oculoplastic surgeons and analyzed. A PubMed MEDLINE database search was done to gather data on the published treatment practices and recommendations. A working group that consisted of in minimum one senior consultant from each leading Nordic University Eye Hospital was assigned. A structured interactive method was used to establish the consensus.ResultsTwenty-four doctors responded to the questionnaire. 23/24 (96%) of the respondents took a biopsy before surgery. Regional lymph node scanning was routinely done by 14/23 (61%) and a systemic screening of a metastatic disease by 13/23 (57%). 6/22 (27%) never took conjunctival mapping biopsies and 12/23 (52%) never screened for Muir- Torre. Respondents used Mohs surgery, frozen section or multi-stage excision with delayed closure, and 5–6 mm was the mostly preferred margin. Sentinel lymph node biopsy was a possible option for 9/22 (41%) and cryotherapy and Mitomycin C for 6/22 (27%) respondents. 50% of respondents considered radiation as a treatment option. 15/16 (94%) respondents always followed-up their patients, most for 5 years. Two thirds scanned regional lymph nodes during the follow-up. Consensus was reached for 18 statements representing three domains: preoperative work-up, treatment and follow-up.ConclusionTreatment practices differ in between the five Nordic countries which have similar public health care systems. In the article the authors present a Nordic consensus for the treatment of eyelid sebaceous carcinoma.

Periocular Sebaceous Carcinoma Masquerading as an Intratarsal Cyst.

A 60-year-old woman with no significant medical history presented to an outside eye care provider for a persistent right lower eyelid lesion. This lesion was diagnosed as a chalazion, and she underwent incision and drainage. Postoperatively, the lesion did not resolve and maintained the same size and appearance. She was referred 6 months later for tarsal cyst excision. Examination was remarkable for an intratarsal cystic lesion involving the margin of the right lower eyelid (Fig. A, B). There was no associated madarosis, ulceration, bleeding, keratinization, or telangiectasia. A wedge excision and reconstruction were performed. Pathologic examination revealed a poorly differentiated sebaceous carcinoma (Fig. C, D). The patient underwent a second resection and conjunctival map biopsies, which showed negative surgical margins and no conjunctival involvement. She subsequently underwent reconstruction, and there was no evidence of recurrence at 6-month follow-up.External photograph demonstrating a right lower eyelid sebaceous cell carcinoma and corresponding histological findings. A,B, The cystic lesion involves the posterior aspect of the tarsus and extends to the margin. C, Lower power photomicrograph demonstrating the cystic growth pattern of the lesion (hematoxylin and eosin; original magnification = ×10). D, High magnification photomicrograph demonstrating that the cyst wall is composed of atypical cells with marked nuclear pleomorphism and vacuolated or foamy cytoplasm in many cells (hematoxylin and eosin; original magnification = ×300).Sebaceous carcinoma is a relatively rare, aggressive malignancy most commonly arising from the periocular tissues including the meibomian glands of the tarsus, and the glands of Zeis of the eyelashes, caruncle, and skin of the eyebrow. Although sebaceous carcinoma accounts for only 0.5% of all eyelid lesions, it is the most concerning because it is associated with increased morbidity and mortality. This periocular malignancy is notoriously difficult to diagnose, masquerading as an assortment of conditions which frequently leads to delays in diagnosis and proper treatment in greater than two thirds of cases. Despite a seemingly benign appearance, any lesion with yellow coloration and thickening of the eyelid or adjacent conjunctiva should cause the clinician to consider sebaceous carcinoma as a possibility with a low threshold for biopsy.

Predictors of Local Recurrence for Eyelid Sebaceous Carcinoma: Questionable Value of Routine Conjunctival Map Biopsies for Detection of Pagetoid Spread.

To identify clinicopathologic factors associated with local recurrence of eyelid sebaceous carcinoma and determine whether routine conjunctival map biopsies are necessary to detect pagetoid spread. The authors searched PubMed for articles on eyelid sebaceous carcinoma and pagetoid spread published in English during 1982 to 2018, and they reviewed 99 consecutive patients with eyelid sebaceous carcinoma who underwent surgical excision with frozen section control of margins performed by 1 author (BE) during 1999 to 2017. Local recurrence rates after surgery were 5% to 25% in the literature and 6% in the authors' cohort. Risk factors for local recurrence included T3b (>20 mm) or worse disease according to the AJCC Cancer Staging Manual, eighth edition, pagetoid spread, diffuse growth pattern, and multicentric origin. Pagetoid spread was observed in 8.3% to 70% of patients in the literature and 31% of patients in the authors' cohort. The literature review showed that surgical excision with frozen section control is the mainstay of management of eyelid sebaceous carcinoma, with topical chemotherapy and cryotherapy used in cases with pagetoid spread. The authors found no solid evidence for added value from routine 4-quadrant conjunctival map biopsies, and some studies called into question their accuracy and yield. In patients with eyelid sebaceous carcinoma, meticulous microscopic margin control is appropriate in all cases and particularly for tumors >20 mm and adjuvant topical chemotherapy should be considered for tumors with conjunctival pagetoid spread. Routine conjunctival map biopsies are not essential, but targeted map biopsies of areas with signs suggestive of pagetoid intraepithelial spread may be appropriate to guide future closer observation or adjuvant treatments.

Eyelid sebaceous carcinoma: Validation of the 8th edition of the American Joint Committee on cancer T staging system and the prognostic factors for local recurrence, nodal metastasis, and survival.

To investigate the clinicopathological features and prognostic factors for eyelid sebaceous gland carcinoma (SGC) in an ethnic Chinese population and to validate the performance of the T category of the 8th edition AJCC staging systems, with the aim of providing information for refinements. Sixty-three patients with pathological diagnosis of SGC were enroled retrospectively. The clinicopathological features, treatments, and outcomes were collected. Prognostic factors associated with the outcome of local recurrence, regional lymph node metastasis, and tumour-related death were analysed. The performance analysis was performed by comparing the predictive value for survival and the monotonicity of gradients between the 7th and 8th staging systems. The distribution of T1:T2:T3:T4 tumours according to the 7th and 8th edition was 6:40:16:1 and 23:26:5:9, respectively. Positive surgical margin was a poor prognostic factor. Local recurrence was associated with more aggressive histopathological features and surrounding structure invasions. Regional lymph node metastasis was associated with larger tumours. The T category of 8th edition showed better predictability for local recurrence and regional lymph node metastasis, while the T category of 7th edition had better monotonicity of gradients. Tumours classified as T2c or worse had higher risk of regional lymph node metastasis, while tumours T3b or worse in the 8th edition had more tumour-related death. Patients with higher T category are at risk of regional lymph node metastasis and tumour-related death. Further refinement of the T category of AJCC staging system can focus on the predictability for local recurrence and the monotonicity of gradients.

This Issue of ACTA

This Issue of ACTA

The practice patterns in the management of sebaceous carcinoma of the eyelid in the Asia Pacific region.

To determine the practice patterns of ophthalmic plastic surgeons regarding the management of eyelid sebaceous carcinoma (SC). An electronic survey was distributed to oculoplastic surgical colleagues in the Asia Pacific region requesting clinical information and treatment approaches to SC. The responses from 192 respondents from the Asia Pacific region was included and analyzed in this study. For initial diagnosis, most surgeons selected incisional biopsy (55%), followed by complete excision (35%). Initial workup was mainly by palpation of lymph nodes, chest X-ray, and computerized tomography scan (CT-scan) of the orbit. Conjunctival map biopsy was done in selected cases. Sentinel lymph node biopsy (SLNB) was done mainly for tumors larger than 10 mm. Management was mainly by surgical excision (5 mm margin) combined with adjuvant therapy in some cases, with radiotherapy being the most common. Margin status was determined most frequently by frozen section as evaluated by the pathologist (57%) followed by Mohs micrographic surgery (18%). Surveillance was based mainly on physical examination alone. The Asia Pacific oculoplastic surgeons prefer incisional biopsy for lesions suspicious of SC prior to definitive surgery. This is in contrast to survey results previously reported in other populations. Frozen section control (done by an oculoplastic surgeon with pathology support) is most commonly used for margin control and conjunctival map biopsies are done only in selected cases. Despite the potential benefits of SLNB, access and expertise in this area is currently lacking in the Asia Pacific region.

Mohs micrographic surgery versus wide local excision for sebaceous adenocarcinoma of the eyelid : Analysis of a national database

Sebaceous adenocarcinomas are rare and potentially aggressive tumors, which typically arise in the periocular region. Surgical treatments for eyelid sebaceous adenocarcinomas include Mohs micrographic surgery (MMS) and wide local excision (WLE). The objective of this study was to compare long-term survival outcomes of MMS versus WLE techniques for eyelid sebaceous adenocarcinomas. A retrospective analysis was performed using data obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registry database. We analyzed cases diagnosed from 1998 to 2015 within the database. Patients diagnosed with sebaceous adenocarcinoma were identified using ICD codes. Cases were limited to primary sebaceous adenocarcinomas involving specifically the eyelid region. The main outcomes were assessed by Kaplan-Meier (KM) survival and Cox proportional hazards model. Sixty-seven cases of MMS were compared with 114 cases of WLE for eyelid sebaceous carcinoma. Overall KM survival rates for MMS compared to WLE at 5-year (75.6% vs. 70.3%) and 10-year follow-up (69.2% vs. 46.9%) did not show significant difference by logrank (P = 0.062). Similarly, after adjusting for demographic, tumor, and treatment characteristics, there was no significant difference in cancer-specific survival (HR 0.45, 95% CI 0.03-6.92, P = 0.57) and overall survival (HR 0.94, 95% CI 0.50-1.74, P = 0.83) when MMS surgical technique was compared with WLE techniques. Our adjusted analyses demonstrated no differences in overall survival or cancer-adjusted survival for patients with eyelid sebaceous adenocarcinomas treated with MMS compared with WLE. In areas requiring preservation of tissue because of cosmetic or functional purposes, MMS is a reasonable surgical approach.

Mohs micrographic surgery for eyelid sebaceous carcinoma: A multicenter cohort of 360 patients

The decision toperform Mohsmicrographic surgery (MMS) or wide local excision (WLE) for eyelid sebaceous carcinoma (SC) is controversial. To compare local recurrence, metastasis, and tumor-related mortality of patients with eyelid SC who were initially treated with MMS versus with WLE. A multicenter cohort study. Medical records were reviewed for factors associated with recurrence, metastasis, and tumor-related mortality. All eligible patients were followed up. The impact of initial surgical modality on the prognoses were determined by Cox analyses after control for all confounders. Of the 360 patients included in this cohort, 115 (31.9%) underwent MMS as primary resection, whereas 245 (68.1%) underwent WLE. After a median follow-up period of 60.0months, local recurrence was observed in 18 patients (15.7%) in the MMS group and 97 patients (39.6%) in the WLE group. Metastasis occurred in 9 patients (7.8%) who underwent MMS and 38 (15.5%) who underwent WLE. In all, 6 patients in the MMS group (5.2%) and 21 in the WLE group (8.6%) died of metastatic SC. Multivariable Cox regression indicated that compared with the WLE group, the MMS group exhibited more favorable local recurrence control (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.24-0.73; P=.002) but a comparable metastasis rate (HR, 1.38; 95% CI, 0.60-3.18; P=.453) and comparable tumor-related mortality (HR, 1.70; 95% CI, 0.59-4.93; P=.329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR, 1.73; 95% CI, 0.37-8.21; P=.488). Retrospective nature of the study. MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control; however, this surgical procedure did not change the long-term outcomes in terms of metastasis ortumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.

An Update on Eyelid Sebaceous Cell Carcinoma.

An Update on Eyelid Sebaceous Cell Carcinoma.

Individualized Prediction and Risk Factors of Recurrence in Chinese Patients with Sebaceous Carcinoma: A Multicenter Study of 418 Patients

Background: Recurrent eyelid sebaceous carcinoma (SC) after primary resection still remains a great challenge for ophthalmologists. The predictors of recurrence are multifactorial, the identification of core risk factors to construct an individualized prediction model is warranted. The purpose of this study is to develop and validate a nomogram for individualized recurrence prediction of eyelid SC and to determine the independent risk factors. Methods: A multicenter cohort study. The study included 418 consecutive patients with eyelid SC, and this sample was divided into training (n=293) and validation cohorts (n=125). Least absolute shrinkage and selection operator (LASSO) regression was applied to select the features for the nomogram. The model was evaluated using the receiver operating characteristic (ROC)-derived area under the curve (AUC), calibration plot, and decision-curve analyses (DCAs), and it was compared with the TNM staging system. These results were externally validated with bootstrap resampling in an independent cohort. Multivariate Cox regression was used to explore the independent predictors of recurrence. Findings: This nomogram displayed satisfactory discriminative ability and good calibration for both the training (C-index: 0.83; AUC: 0.84) and validation (C-index: 0.80; AUC: 0.82) cohorts. The discriminative ability compared significantly favorable than TNM staging (C-index: training cohort: 0.67, validation cohort: 0.71; AUC: training cohort: 0.67, validation cohort: 0.71; all p<0.05). DCA demonstrated that this nomogram was clinically useful. Multivariate Cox regression indicated that diagnostic delay (HR=1.01, 95%CI:1.00-1.01, p=0.001), orbital involvement (HR=4.47, 95%CI:3.04-6.58, p<0.001), Ki 67 (HR=1.01, 95%CI:1.00-1.02, p=0.008) and initial surgical modality (HR=0.53, 95%CI:0.35-0.80, p=0.003) were independent predictors of recurrence. Interpretation: This nomogram provides improved individualized estimates of recurrence after primary excision for Chinese patients with eyelid SC. This model may help guide therapeutic decisions in clinical application. Funding Statement: This work was supported by the National Natural Science Foundation of China (Grants No. 81570884, 81770961) and Innovation Fund for Translational Medicine (15ZH1005), and the Shanghai Shuguang Project (14SG18). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Declaration of Interests: The authors state: No conflict of interest to declare. Ethics Approval Statement: The requirement for informed consent was waived by the institutional review board. The research ethics committees of Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine approved this study. This research strictly followed the tenets of the Declaration of Helsinki.

Contemporary Update of Overall Prognosis and Nomogram to Predict Individualized Survival for Chinese Patients with Eyelid Sebaceous Carcinoma

Background: The prognosis of Chinese patients with eyelid sebaceous gland carcinoma (SC) has not been updated for more than 3 decades. The predictors for the prognoses are multifactorial, there is no validated prognostic model for eyelid SC. Methods: The study included 238 consecutive patients with eyelid SC. All patients were followed up for metastasis and mortality. The predictors of tumor-related survival were explored by Cox analyses. A prognostic nomogram was developed and validated using bootstrap resampling. The predictive accuracy and discriminative ability were compared between nomogram and Tumor, Node, Metastasis (TNM) staging system. Findings: After a median follow-up period of 55.5 months, 27 (11.3%) patients died of the metastatic SC, with a median survival time of 48.0 months. The 5-year and 10-year tumor-related survival rate was 88.1% and 77.9%, respectively. Prior radiation therapy (HR:5.63, p=0.003), tumor with orbital involvement (HR:4.64, p=0.001), greatest tumor basal diameter (HR:1.07, p<0.001), the presence of pagetoid spread (HR:3.12, p=0.012) were the independent risk factors for tumor-related death. Nomogram integrating these 4 factors was developed with a C-index of 0.875, which is significantly better than that of TNM staging system (p=0.038). The risk groups stratified by nomogram scores (p=0.042 (low vs intermediate risk); p<0.001 (intermediate vs high risk)) displayed better discrimination ability than TNM staging (T1vsT2: p=0.358; T2vsT3: p=0.171; T3vsT4: p<0.001) in patients at an early stage. Interpretation: The prognosis of Chinese patients of eyelid SC has been improved for the last 3 decades, and it is comparable to the patients from other countries. This nomogram provides more-accurate individualized estimates of survival for eyelid SC patients, and may guide clinicians in their therapeutic decisions. Funding Statement: This work was supported by the Scientific Research Program of the National Health and Family Planning Commission of China (201402014). Declaration of Interests: The authors declare no conflict of interest in this paper. Ethics Approval Statement: This study adhered to the tenets of the Declaration of Helsinki and was approved by the Shanghai Jiaotong University research ethics committee.

Contemporary update of overall prognosis and nomogram to predict individualized survival for Chinese patients with eyelid sebaceous carcinoma.

BackgroundThe prognosis of Chinese patients with eyelid sebaceous carcinoma (SC) has not been updated for >3 decades. The prognostic predictors are multifactorial, and there is no validated prognostic model for eyelid SC.MethodsThis study included 238 consecutive patients with eyelid SC. All eligible patients were followed up for metastasis and mortality. The predictors of tumor-related survival were explored by Cox analyses. A prognostic nomogram was developed and validated using bootstrap resampling. The predictive accuracy and discriminative ability were compared between the nomogram and the Tumor, Node, Metastasis (TNM) staging system.FindingsAfter a median follow-up period of 55.5 months, 27 (11.3%) patients died of metastatic SC, with a median survival time of 48.0 months. The 5-year and 10-year tumor-related survival rates were 88.1% and 77.9%, respectively. Orbital involvement (HR: 3.11, p = .022), the greatest tumor basal diameter (HR: 1.06, p = .003), the presence of pagetoid spread (HR: 2.90, p = .017), and having lymph node metastasis at initial diagnosis (HR: 13.66, p < .001) were independent risk factors for tumor-related death. A nomogram integrating these 4 factors was developed with a C-index of 0.887, which is significantly better than that of the TNM staging system (p = .002). The risk groups stratified by nomogram scores (p < .001 (low vs intermediate risk); p = .001 (intermediate vs high risk)) displayed better discrimination ability than TNM staging (T1 vs T2: p = .358; T2 vs T3: p = .171; T3 vs T4: p < .001) in patients at an early stage.InterpretationThe prognosis of Chinese patients with eyelid SC has improved over the last 3 decades, and it is comparable to that of patients from other countries. This nomogram provides more accurate individualized estimates of survival for eyelid SC patients and may guide clinicians in their therapeutic decisions.