Contemporary Update of Overall Prognosis and Nomogram to Predict Individualized Survival for Chinese Patients with Eyelid Sebaceous Carcinoma

Background: The prognosis of Chinese patients with eyelid sebaceous gland carcinoma (SC) has not been updated for more than 3 decades. The predictors for the prognoses are multifactorial, there is no validated prognostic model for eyelid SC. Methods: The study included 238 consecutive patients with eyelid SC. All patients were followed up for metastasis and mortality. The predictors of tumor-related survival were explored by Cox analyses. A prognostic nomogram was developed and validated using bootstrap resampling. The predictive accuracy and discriminative ability were compared between nomogram and Tumor, Node, Metastasis (TNM) staging system. Findings: After a median follow-up period of 55.5 months, 27 (11.3%) patients died of the metastatic SC, with a median survival time of 48.0 months. The 5-year and 10-year tumor-related survival rate was 88.1% and 77.9%, respectively. Prior radiation therapy (HR:5.63, p=0.003), tumor with orbital involvement (HR:4.64, p=0.001), greatest tumor basal diameter (HR:1.07, p<0.001), the presence of pagetoid spread (HR:3.12, p=0.012) were the independent risk factors for tumor-related death. Nomogram integrating these 4 factors was developed with a C-index of 0.875, which is significantly better than that of TNM staging system (p=0.038). The risk groups stratified by nomogram scores (p=0.042 (low vs intermediate risk); p<0.001 (intermediate vs high risk)) displayed better discrimination ability than TNM staging (T1vsT2: p=0.358; T2vsT3: p=0.171; T3vsT4: p<0.001) in patients at an early stage. Interpretation: The prognosis of Chinese patients of eyelid SC has been improved for the last 3 decades, and it is comparable to the patients from other countries. This nomogram provides more-accurate individualized estimates of survival for eyelid SC patients, and may guide clinicians in their therapeutic decisions. Funding Statement: This work was supported by the Scientific Research Program of the National Health and Family Planning Commission of China (201402014). Declaration of Interests: The authors declare no conflict of interest in this paper. Ethics Approval Statement: This study adhered to the tenets of the Declaration of Helsinki and was approved by the Shanghai Jiaotong University research ethics committee.