Demographics, clinical features and prognosis of patients with primary malignant conjunctival tumors at a tertiary hospital in Japan.

in Japanese journal of ophthalmology by Hiroshi Goto, Masaki Asakage, Erina Niidime, Naoyuki Yamakawa, Hiroyuki Komatsu, Kinya Tsubota, Kazuhiko Umazume, Yoshihiko Usui, Hideki Mori

TLDR

  • The study analyzed the demographics, clinical features, and prognosis of 359 patients with primary malignant conjunctival tumors in Japan from 2010 to 2022, finding lymphoma to be the most common diagnosis with a favorable prognosis.
  • The study highlights the need for awareness and early detection of malignant conjunctival tumors, particularly in Japan.
  • The study suggests that patients with malignant conjunctival tumors require close monitoring for recurrence and metastasis.

Abstract

To clarify the demographic characteristics, clinical features and prognosis of patients with primary malignant conjunctival tumors diagnosed at a single tertiary hospital in Japan. Retrospective, observational case series. Patients with malignant conjunctival tumors diagnosed histopathologically at Tokyo Medical University Hospital between 2010 and 2022 were retrospectively reviewed. The demographic profile, clinical features and treatment outcomes were analyzed. A total of 359 patients with histopathologically proven malignant conjunctival tumors were included. All patients were Japanese. The most common malignant conjunctival tumor was lymphoma (n = 197, 54.9%), followed by squamous cell carcinoma (SCC) (n = 97, 27.0%), melanoma (n = 60, 16.7%), and others (n = 5, 1.4%). The mean age of patients at the time of diagnosis was 60.5 ± 17.4 years for lymphoma, 60.2 ± 15.8 years for SCC, and 65.8 ± 15.7 years for melanoma. Among 197 patients with lymphoma, 89.3% had extranodal marginal zone lymphoma (EMZL). Lymphomas were treated with external beam radiation therapy in 52.8%, surgical resection with or without cryopexy in 40.1%, and systemic chemotherapy in 4.0%. During an observation period of more than 12 months, recurrence was observed in 8.4% and extraocular lymphoma occurred in 1.7%. In SCC and melanoma, common surgical resection with sufficient safety margin, cryopexy, and application of 0.04% mitomycin C were performed as eye-preserving therapy. Orbital exenteration was performed in advanced cases. Recurrence rates and regional lymph node metastasis rates during an observation period of more than 12 months were, respectively, 30.1% and 6.2% in SCC. Recurrence rates and regional lymph node or distant organ metastasis rates during an observation period of more than 24 months for melanoma were 29% for both. Tumor-related mortality was 16% in melanoma, but 0% in lymphoma and SCC. Lymphoma was the major malignant conjunctival tumor in a Japanese ophthalmology referral center, which may reflect a unique epidemiological trend in Japan compared to Western countries. The prognosis of lymphoma and SCC after appropriate treatment was favorable, except for some cases of advanced SCC.

Overview

  • The study aimed to provide a comprehensive review of the demographic characteristics, clinical features, and prognosis of patients with primary malignant conjunctival tumors diagnosed at Tokyo Medical University Hospital in Japan from 2010 to 2022.
  • The study included 359 patients with histopathologically proven malignant conjunctival tumors, with lymphoma being the most common diagnosis.
  • The study aimed to provide valuable insights into the diagnosis, treatment, and outcome of patients with malignant conjunctival tumors in Japan.

Comparative Analysis & Findings

  • The study found that lymphoma was the most common diagnosis, accounting for 54.9% of cases, followed by squamous cell carcinoma (SCC) at 27.0%, and melanoma at 16.7%.
  • The study found that the prognosis of lymphoma and SCC after appropriate treatment was favorable, except for some cases of advanced SCC.
  • The study found that tumor-related mortality was 16% in melanoma, but 0% in lymphoma and SCC.

Implications and Future Directions

  • The study highlights the importance of awareness and early detection of malignant conjunctival tumors in the Japanese population.
  • Future studies may consider investigating the unique epidemiological trend of lymphoma in Japan compared to Western countries.
  • The study suggests that patients with malignant conjunctival tumors should be closely monitored for recurrence and metastasis.
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