Ocular oncology experts recently evaluated the prognostic value of new criteria (known as AJCC 8) for eyelid and periocular squamous cell carcinoma to determine the association of tumor categorization with recurrence, metastasis, metastasis and disease-specific survival (DSS) for these conditions. 

This retrospective, single-center cohort study of 109 patients found that tumor category in AJCC 8 is associated with nodal metastasis and DSS, noting that immunosuppression and presentation with recurrent disease are associated with increased risk of future local recurrence. The team adds that patients with tumors of clinical stage T2c or worse at presentation are at increased risk of nodal metastasis and worse DSS and should undergo surveillance for nodal metastasis. 

At presentation, the team noted that 43 patients (39.4%) had recurrent tumor, four (3.7%) had nodal metastasis and one (0.9%) had distant metastasis. During the median follow-up period of 23 months, the researchers found 11 patients (10.1%) developed local recurrence, seven (6.4%) developed nodal metastasis, two (1.8%) developed distant metastasis and nine (8.3%) died of disease. They noted that the five-year DSS rate was 87.7%.

The team also noticed that chronic immunosuppression and presentation with recurrent squamous cell carcinoma were associated with local recurrence during follow-up. Of the 11 patients with local recurrence during follow-up, the researchers observed seven (64%) with perineural invasion.

According to the team, tumor category was associated with nodal metastasis, and a clinical stage of T2c or worse at presentation was associated with higher risk of nodal metastasis and death of disease but not with higher risk of local recurrence. They noted that distant metastasis was associated with nodal metastasis at presentation and during follow-up. The researchers added that 33 patients (30.3%) had different tumor categories depending on whether the disease was staged according to the seventh or eighth edition of the AJCC Cancer Staging Manual. Compared with AJCC 7, the team concluded that AJCC 8 showed a better predictive value in terms of local recurrence and DSS.

Xu S, Sagiv O, Rubin ML, et al. Validation study of the AJCC Cancer Staging Manual, eighth edition, staging system for eyelid and periocular squamous cell carcinoma. JAMA Ophthalmol. March 14, 2019. [Epub ahead of print].