New findings from a study recently published in Investigative Ophthalmology and Visual Science evaluated predictors of eyelid sebaceous carcinoma (SC) recurrence to develop a nomogram for personalized prediction in eyelid SC.
Give me some background.
Eyelid SC is a rare and highly malignant cancer that can be difficult to diagnose due to its ability to masquerade as other periocular lesions.
Recurrence is a significant challenge after surgical resection, varying from 6.3 to 37%.
Bring it back to this study.
Currently, staging for eyelid SC is assessed using the Tumor, Node, Metastasis (TNM) definitions provided by the American Joint Committee on Cancer (AJCC).
However: The study authors noted that several important clinical parameters are not considered in this system, such as:
- Pagetoid intraepithelial neoplasia (a form of eyelid SC)
- Histology differentiation
- Demographic factors
- Medical history
- Surgical modalities
As such, they sought to explore the independent predictors of recurrence in eyelid SC to develop and validate a new nomogram risk scoring system for accurate and individualized prediction of recurrent SC.
What is a nomogram?
A nomogram is a graphic scoring system based on statistical models developed to increase the predictive accuracy for individuals.
These models consist of easy-to-collect clinical parameters and can be beneficial to guide therapeutic decisions and optimize patient risk stratification for clinical trial design.
Now talk about the study.
In this retrospective, multicenter cohort study, investigators performed chart reviews on 418 consecutive patients with eyelid SC.
- Researchers followed up with all patients after their initial surgery.
A nomogram for predicting eyelid SC recurrence was developed and validated, and its predictive accuracy and discriminative ability were compared with the above-mentioned TNM staging system.
Note: The primary surgical approaches included wide local excision (WLE) without frozen section control (290 patients [69%]) and Mohs micrographic surgery (MMS) with frozen section control (128 patients [31%]).
Findings?
Over a median 60-month follow-up period, 167 patients (40%) had local recurrence of eyelid SC, and the median time from diagnosis to recurrence was 14 months.
- The 1-year cumulative recurrence rate was 18%.
Independent factors that increased eyelid SC recurrence included:
- Diagnostic delay (hazard ratio [HR] 1.01, 95% confidence interval [CI] 1.00-1.01, P = 0.008)
- Orbital involvement (HR 4.47, 95% CI 3.04-6.58, P < 0.001)
- Ki-67 expression (HR 1.01, 95% CI 1.00-1.02, P = 0.003)
- Note: Ki-67 is a protein only found in dividing cells that can act as a way to measure how fast cancer cells in a tumor are dividing.
Conversely, initial surgery of MMS with intraoperative frozen section control (HR 0.53, 95% CI 0.35-0.80, P = 0.003) was associated with a significantly lower risk of eyelid SC recurrence compared to those who received WLE without intraoperative frozen section control.
What about the nomogram?
The novel nomogram integrated the four factors above with pagetoid spread (a characteristic of SC) to predict the rate of eyelid SC recurrence.
The nomogram displayed satisfactory discriminative ability, and the predictive score was externally replicated in another independent cohort—highlighting its generalizability.
In fact: It demonstrated superior discrimination accuracy than the traditional TNM staging system.
Limitations?
These included:
- Patients were recruited from tertiary hospitals, which may have introduced selection bias and limited generalizability
- The retrospective study design
Take home.
These findings suggest that the recurrence rate is high in eyelid SC and early detection and primary resection with MMS are recommended in controlling recurrence.
Further: Patients with orbital involvement, high Ki-67 expression, and pagetoid spread may require adjuvant measures.
And finally: The novel nomogram provided more accurate recurrence estimates than the traditional system, aiding in clinical decision-making.