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Prognostic factors for local recurrence and survival and impact of local treatments on survival in lacrimal gland carcinoma
  1. Joshua Richard Ford1,
  2. Maria Laura Rubin2,
  3. Steven Jay Frank3,
  4. Jing Ning2,
  5. James Matthew Debnam3,
  6. Diana Bell3,
  7. Adel El-Naggar3,
  8. Renata Ferrarotto4,
  9. Bita Esmaeli1
  1. 1 Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
  2. 2 Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
  3. 3 University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Bita Esmaeli, Joshua R. Ford, Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1488, Houston, TX 77030, USA; besmaeli{at}mdanderson.org

Abstract

Background/aims To identify prognostic factors for local recurrence, distant metastasis and disease-specific survival (DSS) for lacrimal gland carcinoma.

Methods 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.

Results 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).

Conclusions 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.

  • Lacrimal gland
  • Orbit
  • Anatomy
  • Conjunctiva
  • Cosmesis
  • Treatment other
  • Neoplasia
  • Lacrimal drainage

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Footnotes

  • Contributors JRF obtained patient data from extensive chart review and wrote the manuscript in its entirety. MLR and JN are biostatisticians at MD Anderson Cancer Center and oversaw data analysis for this project. SJF is a radiation oncologist, while DB and AE-N are pathologists and RF is an oncologist, at MD Anderson Cancer Center and participated in the care of many patients discussed herein. JMD is a radiologist at MD Anderson Cancer Center and interpreted the radiographs presented herein. BE is the corresponding author for this project and oversaw it in its entirety and participated in the care for the patients discussed herein. All coauthors mentioned helped edit the manuscript.

  • Funding This work was supported by the National Cancer Institute (grant number P30CA016672, which supports the MD Anderson Cancer Center Clinical Trials Office).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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