• Sheetal Chauhan, Seema Sen, Anjana Sharma, Radhika Tandon, Seema Kashyap, Neelam Pushker, Murugesan Vanathi, and Namrata Sharma.
• 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.
• Arch. Pathol. Lab. Med. 2014 Nov 1; 138 (11): 1488-94.

ContextOcular 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.ObjectivesTo evaluate the prognostic relevance of AJCC-TNM staging and the clinicopathological features in OSSN.DesignSixty-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.ResultsLonger 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.ConclusionsA 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.

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