Risk factors associated with nodal metastasis in patients with eyelid sebaceous carcinoma (SC) can include diffuse pattern, orbital invasion, perineural invasion and a high Ki-67 percentage, according to a study published in the British Journal of Ophthalmology. Researchers also developed and validated a nomogram to predict nodal metastasis in these patients as well as guide postoperative management. 

The retrospective case control-control study consisted of 320 patients (184 women, 136 men) with eyelid SC diagnosed with eyelid SC between January 2005 and December 2020. The participants’ median age at diagnosis was 63.0 years (range: 27.0-94.0 years).   

After a median follow-up time of 48.0 months (range: 6.0-178.0 months), the researchers found that 40 patients (12.5%) developed nodal metastasis and 57 patients (17.8%) had local recurrence. The median period between the initial treatment to first nodal metastasis was 18.5 months (range: 6.0-80.0 months). After the follow-up period, 283 (88.4%) patients exhibited no evidence of disease and 37 (11.6%) died. Of the 37 deceased patients, 16 (5.0%) died of the disease and 21 (6.6%) died of an unrelated cause. Based on Kaplan-Meier survival estimates, the 5-year and 10-year disease-specific survival rates were 94.2% and 92.1%, respectively.


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The final multivariable analysis revealed 4 independent risk factors for nodal metastasis: diffuse pattern (HR: 4.34, 95%CI 1.75 to 10.76, P =.002), orbital invasion at presentation (HR: 3.22, 95%CI 1.42 to 7.33, P =.005), perineural invasion (HR: 3.24, 95% CI 1.11 to 9.49, P =.032) and high Ki-67 percentage (HR: 1.03, 95% CI 1.01 to 1.05, P <.001). The investigators constructed a predictive nomogram that included all independent predictors for nodal metastasis. The concordance index for this model was 0.785, indicating a strong ability for predicting nodal metastasis in patients with eyelid SC. 

“The study was the largest single-centre retrospective series of eyelid SC and provided detailed information on nodal metastasis,” according to the researchers. “The proposed nomogram comprised clinicopathological factors besides the T category of tumour, node, metastasis (TNM) staging system and expressed great potential in clinical application.”

Limitations of the research include a relatively small sample size of patients, the possibility of selection bias, and the homogeneous study population in terms of origins. Additionally, the nomogram was not externally validated by independent data from another institution. 

Reference

Gu X, Xie M, Luo Y, Song X, Xu S, Fan X. Diffuse pattern, orbital invasion, perineural invasion and Ki-67 are associated with nodal metastasis in patients with eyelid sebaceous carcinoma. Br J Ophthalmol. Published online January 21, 2022. doi:10.1136/bjophthalmol-2021-320547