Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond

Area of Science:

• Ophthalmology
• Oncology
• Cancer Staging

Background:

• The tumour, node, metastasis (TNM) classification is a long-standing, universal cancer staging system.
• The seventh edition (effective 2010) covers six ophthalmic sites and five cancer types.
• Current TNM staging implementation for eye cancers is limited.

Purpose of the Study:

• To review the application and limitations of the TNM classification system in ophthalmic oncology.
• To highlight its current use in eyelid carcinoma and uveal melanoma.
• To discuss alternative prognostication methods for uveal melanoma and retinoblastoma.

Main Methods:

• Review of the TNM classification system and its application to ophthalmic cancers.
• Analysis of clinical evidence for ciliary body and choroidal melanoma staging.
• Discussion of prognostic factors in retinoblastoma.

Main Results:

• TNM staging is applied to eyelid carcinoma and uveal melanoma, with clinical data supporting uveal melanoma staging (Stage I: 96% 5-year survival; Stage IV: 97% 5-year mortality).
• Chromosomal alterations and gene expression provide more accurate prognostication for uveal melanoma than TNM stage alone.
• Retinoblastoma prognosis often relies on separate international classifications for eye/vision conservation and survival.

Conclusions:

• The TNM cancer staging manual is a valuable tool for ophthalmologists managing eye cancers.
• While TNM staging is useful, especially for uveal melanoma, advanced molecular analyses offer superior prognostic accuracy.
• Further integration of molecular data may enhance TNM staging's utility in ophthalmic oncology.