Prognostic factors for local recurrence and survival and impact of local treatments on survival in lacrimal gland carcinoma

• Published in: British journal of ophthalmology Vol. 105; no. 6; p. 768
• Main Authors: Ford, Joshua Richard, Rubin, Maria Laura, Frank, Steven Jay, Ning, Jing, Debnam, James Matthew, Bell, Diana, El-Naggar, Adel, Ferrarotto, Renata, Esmaeli, Bita
• Format: Journal Article
• Language: English
• Published: England 01-06-2021
• Subjects: Adolescent; Adult; Aged; Carcinoma, Adenoid Cystic - mortality; Carcinoma, Adenoid Cystic - therapy; Child; Combined Modality Therapy; Eye Neoplasms - mortality; Eye Neoplasms - therapy; Female; Humans; Incidence; Lacrimal Apparatus Diseases - mortality; Lacrimal Apparatus Diseases - therapy; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Prognosis; Retrospective Studies; Survival Rate - trends; United States - epidemiology; Young Adult; United States; Cosmesis; Lacrimal gland; Treatment other; Lacrimal drainage; Orbit; Anatomy; Conjunctiva; Neoplasia
• ISSN: 1468-2079
• DOI: 10.1136/bjophthalmol-2020-316142

To identify prognostic factors for local recurrence, distant metastasis and disease-specific survival (DSS) for lacrimal gland carcinoma.
All consecutive patients with lacrimal gland carcinoma treated from January 1998 through December 2018 were included. Log-rank tests and univariate Cox proportional hazards regression models were used to study risk factors and survival.
Overall, 55 patients were included in this study, and 5 patients were excluded from the survival analysis. Median age was 46 years (range: 10-76). 43 patients (78%) had adenoid cystic carcinoma (ACC). 31 patients (56%) had T2 disease at presentation. 28 patients (51%) underwent orbital exenteration with or without adjuvant radiotherapy or chemoradiation, 26 (47%) underwent eye-sparing surgery with or without adjuvant radiotherapy or chemoradiation, and 1 received palliative chemoradiation. 11 patients (22%) experienced local recurrence; 14 (29%) experienced distant metastasis. Five- and 10-year local-recurrence-free survival rates were 0.71 (95% CI 0.58 to 0.88), and 5- and 10-year distant-metastasis-free survival rates were 0.67 (95% CI 0.53 to 0.85) and 0.49 (95% CI 0.30 to 0.81), respectively. There was no significant difference in risks of local recurrence, distant metastasis or DSS between ACC patients who had orbital exenteration and those who had eye-sparing surgery. Perineural invasion was negatively associated with local-recurrence-free survival (p=0.02). Among patients with ACC, basaloid/solid histologic type was associated with significantly worse DSS than non-basaloid/solid histologic type (p<0.01).
For lacrimal gland carcinoma, orbital exenteration with adjuvant therapy and eye-sparing surgery with adjuvant therapy are associated with similar recurrence outcomes. Eye-sparing surgery is associated with better DSS. Perineural invasion is a risk factor for local recurrence. ACC with basaloid/solid subtype correlates with worse DSS.