title: American Joint Committee on Cancer Staging and clinicopathological high-risk predictors of ocular surface squamous neoplasia: a study from a tertiary eye center in India.
abstract: BACKGROUND
  Ocular surface squamous neoplasia (OSSN) is the most common tumor of conjunctival epithelium associated with risk of permanent visual impairment. It includes conjunctival intraepithelial neoplasia and squamous cell carcinoma. Although American Joint Committee on Cancer-TNM (AJCC-TNM) staging is commonly used in various tumors, it has only recently been described for OSSN.
  
  
  OBJECTIVE
  To evaluate the prognostic relevance of AJCC-TNM staging and the clinicopathological features in OSSN.
  
  
  METHODS
  Sixty-four histopathologically proven cases of OSSN (20 conjunctival intraepithelial neoplasia and 44 squamous cell carcinoma) were included in the study. The AJCC-TNM staging and clinicopathological features of OSSN cases were recorded. Patients were followed up for 17 to 40 months (median, 32 months). Univariate and multivariate analyses were performed to determine the prognostic value of various clinicopathological features.
  
  
  RESULTS
  Longer sunlight exposure (P = .01), diffuse growth pattern (P = .02), larger tumor size (≥2 cm) (P = .03), histopathological diagnosis of squamous cell carcinoma (P = .02), and orbital invasion or invasion of adjacent structures (T3 or T4) (P < .001) emerged as significant predictors of reduced recurrence-free survival. Using multivariate analysis, a higher T category (T3 or T4) was the most important prognostic indicator of a poor outcome.
  
  
  CONCLUSIONS
  A higher T category (T3 or T4) is an important predictor of clinical outcome, and the use of the AJCC-TNM staging system is recommended in the management of all patients with OSSN. Longer sunlight exposure, larger tumor size (≥2 cm), orbital invasion or invasion of adjacent structures (T3 or T4), and a histopathological diagnosis of squamous cell carcinoma are other clinicopathological features of prognostic relevance in patients with OSSN.
authors.affiliation: From the Department of Ocular Pathology (Ms Chauhan and Drs Sen and Kashyap), Department of Ocular Microbiology (Dr A. Sharma), Cornea and Refractive Surgery Service (Drs Tandon and N. Sharma), Ophthalmoplasty Service (Dr Pushker), and Cornea and Ocular Surface Service (Dr Vanathi), Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Chauhan
authors.forename: Seema
authors.initials: S
authors.lastname: Sen
authors.forename: Anjana
authors.initials: A
authors.lastname: Sharma
authors.forename: Radhika
authors.initials: R
authors.lastname: Tandon
authors.forename: Seema
authors.initials: S
authors.lastname: Kashyap
authors.forename: Neelam
authors.initials: N
authors.lastname: Pushker
authors.forename: Murugesan
authors.initials: M
authors.lastname: Vanathi
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002648:Child; D003230:Conjunctival Neoplasms / Q000473:pathology; D003316:Corneal Diseases / Q000473:pathology; D005134:Eye Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D016850:Limbus Corneae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D062606:Tertiary Care Centers; D014481:United States; D055815:Young Adult