Association of T and N Categories of the American Joint Commission on Cancer, 8th Edition, With Metastasis and Survival in Patients With Orbital Sarcoma | Intraocular Tumors | JAMA Ophthalmology | JAMA Network
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1.
Mattavelli  D, Miceli  R, Radaelli  S,  et al.  Head and neck soft tissue sarcomas: prognostic factors and outcome in a series of patients treated at a single institution.   Ann Oncol. 2013;24(8):2181-2189. doi:10.1093/annonc/mdt126 PubMedGoogle ScholarCrossref
2.
Koscielniak  E, Morgan  M, Treuner  J.  Soft tissue sarcoma in children: prognosis and management.   Paediatr Drugs. 2002;4(1):21-28. doi:10.2165/00128072-200204010-00003 PubMedGoogle ScholarCrossref
3.
Shields  JA, Shields  CL, Scartozzi  R.  Survey of 1264 patients with orbital tumors and simulating lesions: the 2002 Montgomery Lecture, part 1.   Ophthalmology. 2004;111(5):997-1008. doi:10.1016/j.ophtha.2003.01.002 PubMedGoogle ScholarCrossref
4.
Shields  JA, Bakewell  B, Augsburger  JJ, Donoso  LA, Bernardino  V.  Space-occupying orbital masses in children: a review of 250 consecutive biopsies.   Ophthalmology. 1986;93(3):379-384. doi:10.1016/S0161-6420(86)33731-X PubMedGoogle ScholarCrossref
5.
Kodsi  SR, Shetlar  DJ, Campbell  RJ, Garrity  JA, Bartley  GB.  A review of 340 orbital tumors in children during a 60-year period.   Am J Ophthalmol. 1994;117(2):177-182. doi:10.1016/S0002-9394(14)73074-0 PubMedGoogle ScholarCrossref
6.
Karcioglu  ZA, Hadjistilianou  D, Rozans  M, DeFrancesco  S.  Orbital rhabdomyosarcoma.   Cancer Control. 2004;11(5):328-333. doi:10.1177/107327480401100507 PubMedGoogle ScholarCrossref
7.
Kodet  R, Newton  WA  Jr, Hamoudi  AB, Asmar  L, Wharam  MD, Maurer  HM.  Orbital rhabdomyosarcomas and related tumors in childhood: relationship of morphology to prognosis—an Intergroup Rhabdomyosarcoma study.   Med Pediatr Oncol. 1997;29(1):51-60. doi:10.1002/(SICI)1096-911X(199707)29:1<51::AID-MPO10>3.0.CO;2-7 PubMedGoogle ScholarCrossref
8.
Savar  A, Trent  J, Al-Zubidi  N,  et al.  Efficacy of adjuvant and neoadjuvant therapies for adult orbital sarcomas.   Ophthalmic Plast Reconstr Surg. 2010;26(3):185-189. doi:10.1097/IOP.0b013e3181ba75e6 PubMedGoogle ScholarCrossref
9.
Ophthalmic sites: carcinoma of the eyelid. In: Amin MB, Edge S, Greene FL, et al, eds.  AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017.
10.
World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053PubMedGoogle ScholarCrossref
11.
McNab  AA, Selva  D, Hardy  TG, O’Donnell  B.  The anatomical location and laterality of orbital cavernous haemangiomas.   Orbit. 2014;33(5):359-362. doi:10.3109/01676830.2014.915329 PubMedGoogle ScholarCrossref
12.
Joshi  D, Anderson  JR, Paidas  C, Breneman  J, Parham  DM, Crist  W; Soft Tissue Sarcoma Committee of the Children’s Oncology Group.  Age is an independent prognostic factor in rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children’s Oncology Group.   Pediatr Blood Cancer. 2004;42(1):64-73. doi:10.1002/pbc.10441 PubMedGoogle ScholarCrossref
13.
Dantonello  TM, Int-Veen  C, Winkler  P,  et al.  Initial patient characteristics can predict pattern and risk of relapse in localized rhabdomyosarcoma.   J Clin Oncol. 2008;26(3):406-413. doi:10.1200/JCO.2007.12.2382 PubMedGoogle ScholarCrossref
14.
Shields  JA, Campbell  RJ, Font  RL,  et al. Eye and adnexa: Sarcoma of the orbit. In: Beahrs  OH, Myers MH, eds.  AJCC Manual for Staging of Cancer. 2nd ed. Philadelphia, PA: JB Lippincott Co; 1983:209-211.
15.
Dickinson  AJ, Gausas  RE.  Orbital lymphatics: do they exist?   Eye (Lond). 2006;20(10):1145-1148. doi:10.1038/sj.eye.6702378 PubMedGoogle ScholarCrossref
16.
Potter  BO, Sturgis  EM.  Sarcomas of the head and neck.   Surg Oncol Clin N Am. 2003;12(2):379-417. doi:10.1016/S1055-3207(03)00005-X PubMedGoogle ScholarCrossref
17.
Van Damme  JP, Schmitz  S, Machiels  JP,  et al.  Prognostic factors and assessment of staging systems for head and neck soft tissue sarcomas in adults.   Eur J Surg Oncol. 2010;36(7):684-690. doi:10.1016/j.ejso.2010.05.020 PubMedGoogle ScholarCrossref
18.
Tajudeen  BA, Fuller  J, Lai  C,  et al.  Head and neck sarcomas: the UCLA experience.   Am J Otolaryngol. 2014;35(4):476-481. doi:10.1016/j.amjoto.2014.02.003 PubMedGoogle ScholarCrossref
19.
Behranwala  KA, A’Hern  R, Omar  AM, Thomas  JM.  Prognosis of lymph node metastasis in soft tissue sarcoma.   Ann Surg Oncol. 2004;11(7):714-719. doi:10.1245/ASO.2004.04.027 PubMedGoogle ScholarCrossref
20.
Fong  Y, Coit  DG, Woodruff  JM, Brennan  MF.  Lymph node metastasis from soft tissue sarcoma in adults: analysis of data from a prospective database of 1772 sarcoma patients.   Ann Surg. 1993;217(1):72-77. doi:10.1097/00000658-199301000-00012 PubMedGoogle ScholarCrossref
21.
Fisher  SB, Chiang  YJ, Feig  BW,  et al.  Comparative performance of the 7th and 8th editions of the American Joint Committee on Cancer Staging Systems for soft tissue sarcoma of the trunk and extremities.   Ann Surg Oncol. 2018;25(5):1126-1132. doi:10.1245/s10434-018-6378-9Google ScholarCrossref
22.
Shields  JA, Shields  CL.  Rhabdomyosarcoma: review for the ophthalmologist.   Surv Ophthalmol. 2003;48(1):39-57. doi:10.1016/S0039-6257(02)00415-0 PubMedGoogle ScholarCrossref
23.
Nathan  H, Raut  CP, Thornton  K,  et al.  Predictors of survival after resection of retroperitoneal sarcoma: a population-based analysis and critical appraisal of the AJCC staging system.   Ann Surg. 2009;250(6):970-976. doi:10.1097/SLA.0b013e3181b25183 PubMedGoogle ScholarCrossref
24.
Corey  RM, Swett  K, Ward  WG.  Epidemiology and survivorship of soft tissue sarcomas in adults: a national cancer database report.   Cancer Med. 2014;3(5):1404-1415. doi:10.1002/cam4.288 PubMedGoogle ScholarCrossref
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    Original Investigation
    February 27, 2020

    Association of T and N Categories of the American Joint Commission on Cancer, 8th Edition, With Metastasis and Survival in Patients With Orbital Sarcoma

    Author Affiliations
    • 1Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
    • 2Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
    • 3Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
    • 4Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
    • 5Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
    • 6Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston
    JAMA Ophthalmol. 2020;138(4):374-381. doi:10.1001/jamaophthalmol.2020.0039
    Key Points

    Question  What is the association of T and N categories at presentation according to the American Joint Commission on Cancer, 8th edition, classification for orbital sarcoma with disease-related outcomes?

    Findings  In this single-center cohort study including 73 patients with orbital sarcoma, T3 category or greater was associated with higher risk of all disease-related outcomes, including local recurrence, lymph node metastasis, distant metastasis, and death due to disease. N1 disease was associated with a higher risk of distant metastasis and death due to disease.

    Meaning  These findings appear to support consideration of strict surveillance testing for regional nodal and systemic metastases in patients with a disease category of T3 or greater or with N1 disease at presentation.

    Abstract

    Importance  No previous studies to date have validated the American Joint Committee on Cancer (AJCC) 8th edition of the TNM classification for orbital sarcoma.

    Objectives  To determine the prognostic performance of the most recent TNM classification for orbital sarcoma and to identify other prognostic factors for local recurrence, lymph node metastasis, distant metastasis, and death due to disease.

    Design, Setting, and Participants  This single-center retrospective cohort study included 73 consecutive patients treated for orbital sarcoma from March 1, 2003, through June 30, 2018. Data were analyzed from November 1 to December 31, 2018.

    Main Outcomes and Measures  T and N categories at presentation and disease-related outcomes, including local recurrence, lymph node metastasis, distant metastasis (DM), and death due to disease (DD).

    Results  The 73 participants included 43 men (59%), and the median age was 21 (range, 0-77) years. The common histologic types were rhabdomyosarcoma (RMS) (35 [48%]), solitary fibrous tumor/hemangiopericytoma (10 [14%]), and Ewing sarcoma (8 [11%]). The most common TNM designations were T2 N0 M0 (26 [36%]) and T4 N0 M0 (24 [33%]). T category was associated with the risk of all disease-related outcomes, including local recurrence (hazard ratio [HR] for T2 vs T4, 0.22 [95% CI, 0.06-0.81]; HR for T3 vs T4, 0.59 [95% CI, 0.13-2.65]; P = .03), lymph node metastasis by the last follow-up (T1, 1 [14%]; T2, 0; T3, 0; T4, 12 [35%]; P = .001), DM (HR for T2 vs T4, 0.29 [95% CI, 0.08-1.07]; P = .04), and DD (HR of T2 vs T4, 0.16 [95% CI, 0.04-0.73]; HR of T3 vs T4, 0.30 [95% CI, 0.04-2.34]; P = .02). Higher risk of DM and higher risk of DD were associated with disease category of at least T3 (HR for DM, 3.24 [95% CI, 0.89-11.72; P = .06]; HR for DD, 6.32 [95% CI, 1.43-27.95; P = .005]), N1 disease (HR for DM, 13.33 [95% CI, 4.07-43.65; P < .001]; HR for DD, 7.07 [95% CI, 2.45-20.44; P < .001]), tumor size larger than 3 cm (HR for DM, 2.72 [95% CI, 0.92-8.05; P = .06]; HR for DD, 5.79 [95% CI, 1.85-18.14; P < .001]), and age of patient with RMS younger than 1 year or 10 years or older (HR for DM, 6.85 [95% CI, 0.83-56.53; P = .04]; HR for DD, 7.03 [95% CI, 0.85-57.83; P = .04]). Higher risk of local recurrence was associated with disease category of at least T3 (HR for<T3 vs≥T3, 0.20 [95% CI, 0.06-0.71]; P < .01) and tumor size greater than 3 cm (HR for ≤3 cm vs >3 cm, 0.27 [95% CI, 0.09-0.77]; P = .009). Higher risk of lymph node metastasis was associated with disease category of at least T3 (odds ratio [OR], 13.33 [95% CI, 1.77-602.30]; P = .004), alveolar RMS (OR, 9.98 [95% CI, 2.13-51.55]; P = .001), and age of patient with RMS younger than 1 year or 10 years or older (OR, 9.20 [95% CI, 1.01-458.29] P = .03).

    Conclusions and Relevance  In patients with orbital sarcoma, T and N categories at presentation (defined by the AJCC 8th edition classification) correlate with metastasis and survival. These findings appear to support consideration of strict surveillance testing for regional nodal and systemic metastases in patients with orbital sarcoma with disease category of at least T3 and/or N1 disease.

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