American Joint Committee on Cancer Staging and Clinicopathological High-Risk Predictors of Ocular Surface Squamous Neoplasia: A Study From a Tertiary Eye Center in India

Abstract

Context.-Ocular surface squamous neoplasia (OSSN) is the most common tumor of conjunctival epithelium associated with risk of permanent visual impairment. It includes conjunctival intraepithelial neoplasia and squamous cell carcinoma. Although American Joint Committee on Cancer-TNM (AJCC-TNM) staging is commonly used in various tumors, it has only recently been described for OSSN.Objectives.-To evaluate the prognostic relevance of AJCC-TNM staging and the clinicopathological features in OSSN.Design.-Sixty-four histopathologically proven cases of OSSN (20 conjunctival intraepithelial neoplasia and 44 squamous cell carcinoma) were included in the study. The AJCC-TNM staging and clinicopathological features of OSSN cases were recorded. Patients were followed up for 17 to 40 months (median, 32 months). Univariate and multivariate analyses were performed to determine the prognostic value of various clinicopathological features.Results.-Longer sunlight exposure (P ¼ .01), diffuse growth pattern (P ¼ .02), larger tumor size (2 cm) (P ¼ .03), histopathological diagnosis of squamous cell carcinoma (P ¼ .02), and orbital invasion or invasion of adjacent structures (T3 or T4) (P , .001) emerged as significant predictors of reduced recurrence-free survival. Using multivariate analysis, a higher T category (T3 or T4) was the most important prognostic indicator of a poor outcome.Conclusions.-A higher T category (T3 or T4) is an important predictor of clinical outcome, and the use of the AJCC-TNM staging system is recommended in the management of all patients with OSSN. Longer sunlight exposure, larger tumor size (2 cm), orbital invasion or invasion of adjacent structures (T3 or T4), and a histopathological diagnosis of squamous cell carcinoma are other clinicopathological features of prognostic relevance in patients with OSSN.

Extending far and wide: the role of biopsy and staging in the management of ocular surface squamous neoplasia

“…Although Nanji et al found no increased risk of recurrence with respect to AJCC classification, others demonstrated significant reduction in recurrence‐free survival with higher T categories. Chauhan et al and Yousef and Finger, for example, showed higher T category (T3 or T4; involvement of adjacent structures or the orbit, respectively) to be an important predictor of tumour recurrence . Galor et al similarly demonstrated an increased risk of recurrence for more extensive lesions (stages T2 and T3; >5 mm in greatest dimension and involving adjacent structures, respectively) than for smaller lesions (stage T1; ≤5 mm in greatest dimension) .…”

“…Galor et al similarly demonstrated an increased risk of recurrence for more extensive lesions (stages T2 and T3; >5 mm in greatest dimension and involving adjacent structures, respectively) than for smaller lesions (stage T1; ≤5 mm in greatest dimension) . As a result, some institutions have recommended routine tumour staging with histopathologic confirmation as a necessary adjunct in the management of every OSSN patient …”

“…However, although these studies emphasized the predictive value of clinical staging (based on clinical appearance of the tumours, as in the 7th edition of the AJCC clinical staging criteria), it should be clearly noted that not all patients in these earlier studies underwent excisional (or incisional) biopsy and thus many were staged based on clinical features only—a method that is less compatible with more recent AJCC 8th edition staging. Additionally, in many of these previous studies stage Tis was not even utilized in classifying tumours even though multiple cases demonstrated biopsy‐proven carcinoma in situ . This disparity raises questions as to how prior findings translate to the more recent AJCC staging definitions—especially given the ambiguity in interpreting current stage T3 criteria—and whether prior recommendations of routine staging should still hold true today.…”

p16INK4a overexpression as a predictor of survival in ocular surface squamous neoplasia

“…Earlier studies have reported that patients with higher American Joint Committee on Cancer (AJCC) TNM category of T3 or T4 (infiltration of the orbit and intraocular structures) are at a higher risk of reduced disease-free survival 2. In order to improve the survival rate of patients with OSSN, identification of biomarkers which predict poor prognosis is important.…”

Differential Expression of Stem Cell Markers in Ocular Surface Squamous Neoplasia

“…However, OSSN is considered as a low-grade malignancy. In a recent study of 64 cases with OSSN by Chauhan et al, 18% cases with squamous cell carcinoma developed metastasis and 12% died[7], as compared to earlier reports of metastasis varying from 0 to 8%[8]. Similarly, many groups did not support an association between histopathological grade and recurrence [9,10].…”