Eyelid sebaceous gland carcinoma: An assessment of the T classification of the American Joint Committee of Cancer TNM staging system 8th versus 7th edition

Abstract

Purpose: To assess the prognostic values of the T classification of the 8th edition of the American Joint Committee of Cancer staging system and compare it to the 7th edition. Methods: Multicenter retrospective study of patients with eyelid sebaceous gland carcinoma. The primary outcome measure was the differences between outcomes when tumors were staged with either 7th or 8th edition. The measures evaluated included presenting features, management, histopathology, metastasis, recurrence, and mortality. Results: Of the 60 patients (median age 73 years), 31 (51.7%) were females. A change in T staging occurred in 39 patients (65%) when the 8th edition was applied. Advanced categories (T3/T4) were significantly associated with nodal metastasis ( p = 0.037) using the 8th edition criteria but not with the 7th edition ( p = 0.066). The 8th edition T categorization significantly correlated with eye survival ( p = 0.022) while the 7th edition did not ( p = 0.058). Applying the 8th edition, category T4 at presentation was associated with a higher risk of nodal metastasis ( p = 0.037) but not associated with local recurrence, distant metastasis, or tumor-related death ( p = 0.281, p = 0.737, p = 0.319, respectively). T3/T4 category tumors were significantly associated with poor tumor differentiation ( p = 0.001), and papillary histologic pattern ( p = 0.024) but not with pagetoid spread ( p = 0.056). Conclusion: The application of the 8th edition AJCC staging system for eyelid SGC may accurately predict nodal metastasis. Local recurrence and distant metastasis were not significantly associated with T classification, using either edition. Poor tumor differentiation and papillary pattern were associated with T3/T4 categories suggesting that pathological features may assist in determining prognosis.

Sebaceous gland carcinoma: analysis based on the 8th edition of American Joint Cancer Committee classification

“…Both these factors in conjunction may contribute to improved accuracy in predicting regional lymph node metastasis. Studies report that patients who developed nodal metastasis had greater tumour size and also showed features such as eyelid margin or tarsal plate invasion beyond the tumour nidus [6]. In our study, a correlation between T category and nodal metastasis was noted with T4 category tumours showing the highest rate of metastasis.…”

“…Hsia et al found an association of local recurrence with aggressive histopathological patterns and extent of tumour invasion into surrounding tissues, but not with tumour size [8]. AlHammad et al did not note a significant correlation between tumour recurrence and advanced disease in their cohort [6]. In our study, tumour recurrence was higher in T2 tumours but there was no statistically significant correlation between T category and tumour recurrence.…”

“…Categorization of eyelid carcinomas with the AJCC TNM classification allows risk stratification to provide guidelines for management in terms of both survival and local tumour control [4]. Application of the 8 th edition results in recategorization of tumours (previously assigned based on the 7th AJCC edition) into new T categories [5,6,[8][9][10]. The major differences between 7 th and 8 th editions of AJCC classification of periocular SGC is the definition of T1 (tumours size 10 mm or less in 8 th edition vs 5 mm or less in 7 th edition) resulting in down staging of the disease when classified using 8 th edition of AJCC.…”

“…The major differences between 7 th and 8 th editions of AJCC classification of periocular SGC is the definition of T1 (tumours size 10 mm or less in 8 th edition vs 5 mm or less in 7 th edition) resulting in down staging of the disease when classified using 8 th edition of AJCC. Also, all T categories in the 8 th edition are classified based on clinical features including tumour size and extent of ocular/ periocular invasion without any consideration of histopathology features or type of surgical treatment [5,6,[8][9][10].…”

“…Furthermore, 'perineural invasion' has been eliminated as an automatic upstaging to T3a [5]. It has been reported that the application of the 8th edition of the classification may also predict regional lymph node metastasis with greater accuracy [6].…”