Nomogram for Preoperative Estimation of Orbit Invasion Risk in Periocular Squamous Cell Carcinoma

Abstract

Importance: Orbital invasion occurs in some periocular squamous cell carcinoma (SCC), compromising surgical outcomes, and prognoses of patients. To date, however, there are no validation studies on the clinical features related to orbital invasion in patients with periocular SCC. Objective: To explore clinical features that may be associated with orbital invasion and build a model for predicting the risk of orbital invasion. Design, Setting, and Participants: In this retrospective mono-center case-control study, 90 patients with periocular SCC were treated at the Ninth People's Hospital Shanghai Jiao Tong University School of Medicine from January 2005 to August 2019. "Case" is defined as a SCC patient with orbit invasion prior to operation. "Exposure" is defined as the different sites of lesion. Main Outcomes and Measures: Clinical features, including "time to relapse after surgery," were collected. Multivariate logistic regression analysis was applied to identify the independent risk clinical features associated with orbital invasion, which was then incorporated into a nomogram. Results: Of the 90 patients included in this study, 33 patients (36.7%) had orbital invasion. 14 of the 33 orbit-invasive patients had local recurrence, while 11 of 57 orbit non-invasive patients had local recurrence, suggesting that orbital invasion is a risk factor for local recurrence. The multivariate binary logistic regression indicated that the lesions at the medial canthus [odds ratio (OR), 5.024, 95% CI, 1.409-17.912, P = 0.013], the age at diagnosis (10-years intervals; OR, 0.590, 95% CI, 0.412-0.844, P = 0.004), and bleeding in the lesion (OR, 3.480, 95% CI, 1.254-9.660, P = 0.017) were three preoperative clinical features significantly associated with orbital invasion. Conclusion: For periocular SCC, lesions at the medial canthus, the younger age of the patients at diagnosis, and bleeding in the lesion were the three main clinical features associated with orbital invasion. The risk score model for orbital invasion can act as a supportive tool for optimized clinical evaluation and treatment decisions.

Development and validation of a nomogram to predict the recurrence of eyelid sebaceous gland carcinoma

“…Reliable nomograms can be of immense value in predicting the prognosis of eyelid tumors and other malignancies, assisting patients in decision-making, and aiding healthcare providers in personalizing clinical treatments. [30][31][32][33] The traditional AJCC classification system focuses on the tumor's largest diameter and invasion profile. However, our retrospective study showed that the degree of pathological differentiation, Ki67 expression, and pagetoid infiltration of the conjunctival epithelium could also increase the risk of recurrence, with specific predictive value.…”

“…Notably, nomograms are renowned for their superior accuracy, specificity, and sensitivity. Reliable nomograms can be of immense value in predicting the prognosis of eyelid tumors and other malignancies, assisting patients in decision‐making, and aiding healthcare providers in personalizing clinical treatments 30–33 . The traditional AJCC classification system focuses on the tumor's largest diameter and invasion profile.…”

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

“…Nomogram is a visual tool that employs statistical models to provide personalised risk estimates and improve management-related decisions in various carcinomas. 35 A robust nomogram was established in our study to predict the development of nodal metastasis of eyelid SC and therefore contributes to the postoperative hierarchical management and selection of candidates for trials designed to evaluate preventive interventions. A suggested follow-up formulation based on the risk stratification of this nomogram was in figure 1B .…”

Perineural invasion and perineural spread in periocular squamous cell carcinoma

“…It often occurs concurrently with other high-risk features including large tumour size, poor histological differentiation, lymphovascular invasion and chronic immunosuppression [5]. The incidence of PNI is reported to be 2.5-14.0% of head and neck SCC [4,6,7], and 4.3-14.4% of periocular SCC [8][9][10][11][12]. Other studies of eyelid SCCs have reported a higher incidence of PNI ranging from 23.8 to 36.7%, which may be explained by more advanced disease at presentation [13][14][15].…”