Prognostic factors for local recurrence and survival and impact of local treatments on survival in lacrimal gland carcinoma

Br J Ophthalmol. 2021 Jun;105(6):768-774. doi: 10.1136/bjophthalmol-2020-316142. Epub 2020 Jul 17.


Background/aims: To identify prognostic factors for local recurrence, distant metastasis and disease-specific survival (DSS) for lacrimal gland carcinoma.

Methods: All consecutive patients with lacrimal gland carcinoma treated from January 1998 through December 2018 were included. Log-rank tests and univariate Cox proportional hazards regression models were used to study risk factors and survival.

Results: Overall, 55 patients were included in this study, and 5 patients were excluded from the survival analysis. Median age was 46 years (range: 10-76). 43 patients (78%) had adenoid cystic carcinoma (ACC). 31 patients (56%) had T2 disease at presentation. 28 patients (51%) underwent orbital exenteration with or without adjuvant radiotherapy or chemoradiation, 26 (47%) underwent eye-sparing surgery with or without adjuvant radiotherapy or chemoradiation, and 1 received palliative chemoradiation. 11 patients (22%) experienced local recurrence; 14 (29%) experienced distant metastasis. Five- and 10-year local-recurrence-free survival rates were 0.71 (95% CI 0.58 to 0.88), and 5- and 10-year distant-metastasis-free survival rates were 0.67 (95% CI 0.53 to 0.85) and 0.49 (95% CI 0.30 to 0.81), respectively. There was no significant difference in risks of local recurrence, distant metastasis or DSS between ACC patients who had orbital exenteration and those who had eye-sparing surgery. Perineural invasion was negatively associated with local-recurrence-free survival (p=0.02). Among patients with ACC, basaloid/solid histologic type was associated with significantly worse DSS than non-basaloid/solid histologic type (p<0.01).

Conclusions: For lacrimal gland carcinoma, orbital exenteration with adjuvant therapy and eye-sparing surgery with adjuvant therapy are associated with similar recurrence outcomes. Eye-sparing surgery is associated with better DSS. Perineural invasion is a risk factor for local recurrence. ACC with basaloid/solid subtype correlates with worse DSS.

Keywords: Anatomy; Conjunctiva; Cosmesis; Lacrimal drainage; Lacrimal gland; Neoplasia; Orbit; Treatment other.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carcinoma, Adenoid Cystic / mortality*
  • Carcinoma, Adenoid Cystic / therapy
  • Child
  • Combined Modality Therapy
  • Eye Neoplasms / mortality*
  • Eye Neoplasms / therapy
  • Female
  • Humans
  • Incidence
  • Lacrimal Apparatus Diseases / mortality*
  • Lacrimal Apparatus Diseases / therapy
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology*
  • Prognosis
  • Retrospective Studies
  • Survival Rate / trends
  • United States / epidemiology
  • Young Adult