Objective: To investigate the main indications and prognosis of patients undergoing orbital exenteration (OE). Methods: It was a retrospective case series study. The medical records were collected of patients who underwent OE surgery at Beijing Tongren Hospital from January 2007 to December 2021, and their general information, tumor characteristics, lymph node metastasis, diagnosis and treatment, specific surgical techniques, pathological diagnosis and prognosis were analyzed. Kaplan-Meier survival curves were used to evaluate overall survival and recurrence-free survival. Results: A total of 147 patients were included, with a median age of 58 (48, 68) years. Among them, 82 patients (55.8%) were male and 65 (44.2%) were female, and all underwent unilateral OE. Five patients (3.4%) had benign lesions. Among the 142 patients with malignant tumors, conjunctival malignancies (37.3%) were the most common, followed by eyelid (29.6%), orbital (19.0%), and ocular (14.1%) malignancies. Among the 53 patients with conjunctival tumors, 38 (71.7%) had conjunctival melanoma and 14 (26.4%) had squamous cell carcinoma. Among the 42 patients with eyelid malignancies, 19 (45.2%) had sebaceous gland carcinoma and 16 (38.1%) had basal cell carcinoma. Among the 20 patients with ocular malignancies, 10 (50.0%) had choroidal melanoma and 9 (45.0%) had retinoblastoma. The most common pathological types among the 142 patients with malignant tumors were melanoma (51 cases, 35.9%), squamous cell carcinoma (20 cases, 14.1%), sebaceous gland carcinoma (19 cases, 13.4%), and basal cell carcinoma (16 cases, 11.3%). Of the 135 patients included in the survival analysis, all 5 patients with benign lesions were alive at the last follow-up. The median follow-up time for the 130 patients with malignant tumors was 6.9 (2.5, 6.9) years, ranging from 0.2 to 14.0 years. The overall survival rates at 1, 3, and 5 years after surgery were 90.9% (95%CI: 85.8%-96.0%), 68.4% (95%CI: 59.6%-77.2%), and 60.1% (95%CI: 50.5%-69.7%), respectively. The recurrence-free survival rates of patients with and without lymph node metastasis before surgery were 57.6% and 56.7%, respectively (OR=1.062, 95% CI: 0.525-2.148, P=0.864), and the overall survival rates were 61.5% and 57.7%, respectively (OR=1.019, 95% CI: 0.512-2.033, P=0.957), with no significant differences both. The recurrence-free survival rates of patients with melanoma (47 cases) and non-melanoma (83 cases) were 40.4% and 67.5%, respectively (OR=2.576, 95% CI: 1.390-4.775, P<0.001), and the overall survival rates were 42.6% and 67.5%, respectively (OR=2.845, 95% CI: 1.549-5.225, P<0.001), with significant differences both. Conclusions: The primary indications for OE are malignant tumors of the conjunctiva and eyelids, with melanoma being the most common malignant tumor of the conjunctiva. Melanoma patients who undergo OE have a lower survival rate compared to other types of malignant tumors. Nevertheless, even in the presence of tumor lymph node metastasis, patients can achieve a relatively good prognosis through OE.
目的： 探讨行眶内容摘除术（OE）患者的手术主要原因及预后情况。 方法： 回顾性病例系列研究。连续收集2007年1月至2021年12月在北京同仁医院行OE患者的病历资料，分析患者的一般情况，肿瘤、复发、淋巴结转移、诊疗、具体术式、预后情况以及组织病理学诊断资料等。采用Kaplan-Meier法绘制生存曲线，评估患者的总生存期和无复发生存期。 结果： 纳入患者共147例，年龄为58（48，68）岁。其中男性82例（55.8%），女性65例（44.2%）；均为单眼行OE；其中5例（3.4%）患者为良性病变。在142例恶性肿瘤患者中，结膜恶性肿瘤（37.3%）占比最高，其后依次为眼睑（29.6%）、眼眶（19.0%）和眼球（14.1%）恶性肿瘤。在53例结膜肿瘤患者中，38例（71.7%）为结膜黑色素瘤，14例（26.4%）为结膜鳞状细胞癌；在42例眼睑恶性肿瘤中，19例（45.2%）为皮脂腺癌，16例（38.1%）为基底细胞癌；在20例眼球恶性肿瘤中，10例（50.0%）为脉络膜黑色素瘤，9例（45.0%）为视网膜母细胞瘤。在142例恶性肿瘤患者中，组织病理学类型占比最高的前4位依次为黑色素瘤［51例（35.9%）］、鳞状细胞癌［20例（14.1%）］、皮脂腺癌［19例（13.4%）］和基底细胞癌［16例（11.3%）］。在纳入生存分析的135例患者中，5例良性病变患者截至末次随访均存活。130例恶性肿瘤患者随访时间为6.9（2.5，6.9）年，范围为0.2~14.0年。术后患者1年、3年和5年的总生存率分别为90.9%（95%CI：85.8%~96.0%）、68.4%（95%CI：59.6%~77.2%）和60.1%（95%CI：50.5%~69.7%）。术前淋巴结转移和无淋巴结转移患者无复发生存率分别为57.6%和56.7%（OR=1.062，95%CI：0.525~2.148，P=0.864），总生存率分别为61.5%和57.7%，（OR=1.019，95%CI：0.511~2.033，P=0.957），差异均无统计学意义；黑色素瘤（47例）和非黑色素瘤（83例）患者无复发生存率分别为40.4%和67.5%（OR=2.576，95%CI：1.390~4.775，P<0.001），总生存率分别为42.6%和67.5%（OR=2.845，95%CI：1.549~5.225，P<0.001），差异均有统计学意义。 结论： 患者行OE主要原因为结膜及眼睑恶性肿瘤，结膜恶性肿瘤中以黑色素瘤为主。黑色素瘤患者行OE后生存率低于其他类型恶性肿瘤。即便发生肿瘤淋巴结转移，患者仍可通过行OE获得较好预后。.