title: Comparison of American Joint Committee on Cancer TNM-based staging system (7th edition) and Ann Arbor classification for predicting outcome in ocular adnexal lymphoma.
abstract: OBJECTIVE
  To compare the TNM and Ann Arbor staging systems in predicting outcome in ocular adnexal lymphoma (OAL).
  
  
  METHODS
  Retrospective review of the clinical, imaging and histopathologic records of OALs between 1986 and 2009. Outcome measures included local recurrence and progression.
  
  
  RESULTS
  One hundred and sixty patients of OAL were included. Mean age was 65 ± 15 years (range 20-97) and 68 (43%) were male. The median follow-up of all OAL patients was 65 months (range 2.5-238). Histopathology identified low-grade, indolent B-cell lymphomas in 140 patients (87.5%) and rest had aggressive grades. Of 134 indolent OAL patients, those with unilateral disease had a 10-year progression free survival of 72% versus 48% in their bilateral counterparts (p = 0.001). Amongst unilateral OAL patients staged within the T1-2 group, a significantly better outcome was noted for patients without nodal or metastatic involvement compared to those with such involvement (p = 0.0001). The above observations helped to formulate a simple scoring system to prognosticate OALs based on their laterality and node/metastatic status. Amongst the 3 groups identified, group 1 with a score of 0 (unilateral OALs with no nodes or metastasis) had a 10-year progression free survival of 75%; group 2 with score 1 (either bilateral or positive nodes/metastasis) 50% and group 3 with score 2 (both bilateral OAL with positive nodes/metastasis) zero at 10 years (p < 0.00001).
  
  
  CONCLUSIONS
  The TNM-based staging system better predicts outcome in OAL than the Ann Arbor system primarily by delineation of bilateral disease and nodal/metastatic involvement at presentation.
authors.affiliation: Department of Ophthalmology and Visual Sciences , University of British Columbia, Vancouver, Canada .
authors.forename: Suryasnata
authors.initials: S
authors.lastname: Rath
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Connors
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dolman
authors.forename: Jack
authors.initials: J
authors.lastname: Rootman
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Rootman
authors.forename: Valerie A
authors.initials: VA
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003230:Conjunctival Neoplasms / Q000145:classification / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008228:Lymphoma, Non-Hodgkin / Q000145:classification / Q000473:pathology*; D008297:Male; D008495:Medical Oncology / Q000458:organization & administration; D008875:Middle Aged; D009367:Neoplasm Staging; D009918:Orbital Neoplasms / Q000145:classification / Q000473:pathology*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult