Surgery Versus Interferon Alpha-2b Treatment Strategies for Ocular Surface Squamous Neoplasia: A Literature-Based Decision Analysis

Andrew N. Siedlecki, Stephanie Tapp, Anna N A Tosteson, Robin J. Larson, Carol Karp, Thomas Lietman, Michael E. Zegans

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: To compare treatment strategies for ocular surface squamous neoplasia (OSSN), ranging from surgical excision to empiric topical interferon alpha-2b (IFN-a2b). Methods: A decision model was constructed to determine which of 4 treatment strategies minimized expected persistence/recurrence of disease in patients with OSSN: excision followed by repeat excision for positive surgical margins, excision followed by IFN-a2b for positive margins, incisional biopsy followed by IFN-a2b for positive biopsies, and empiric treatment with IFN-a2b. Probabilities were estimated from literature published between 1983 and 2015. Expected values for the probability of recurrence could range from 0 (no persistence/recurrence) to 1 (persistence/recurrence). Sensitivity analyses were performed for each variable.Results: Excision followed by IFN-a2b for positive margins was estimated to minimize persistence/recurrence of OSSN (expected value 0.13 versus 0.17 for empiric IFN-a2b, 0.22 for excision-only, and 0.30 for incisional biopsy-directed IFN-a2b). The optimal strategy was sensitive to 3 variables: efficacy of IFN-a2b, recurrence after negative surgical margins, and accuracy of excisional biopsy. Conclusions: In our decision analysis using studies published between 1983 and 2015, surgical excision followed by IFN-a2b for positive margins is the favored strategy for minimizing persistence/ recurrence of OSSN. Future prospective studies would add to the certainty of these conclusions.

Original languageEnglish (US)
Pages (from-to)613-618
Number of pages6
JournalCornea
Volume35
Issue number5
DOIs
StatePublished - 2016

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interferon alfa-2b
Decision Support Techniques
Recurrence
Neoplasms
Biopsy
Therapeutics

Keywords

  • decision analysis
  • eye neoplasms
  • interferon alpha-2b
  • ocular surface squamous neoplasia

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Surgery Versus Interferon Alpha-2b Treatment Strategies for Ocular Surface Squamous Neoplasia : A Literature-Based Decision Analysis. / Siedlecki, Andrew N.; Tapp, Stephanie; Tosteson, Anna N A; Larson, Robin J.; Karp, Carol; Lietman, Thomas; Zegans, Michael E.

In: Cornea, Vol. 35, No. 5, 2016, p. 613-618.

Research output: Contribution to journalArticle

Siedlecki, Andrew N. ; Tapp, Stephanie ; Tosteson, Anna N A ; Larson, Robin J. ; Karp, Carol ; Lietman, Thomas ; Zegans, Michael E. / Surgery Versus Interferon Alpha-2b Treatment Strategies for Ocular Surface Squamous Neoplasia : A Literature-Based Decision Analysis. In: Cornea. 2016 ; Vol. 35, No. 5. pp. 613-618.
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N2 - Purpose: To compare treatment strategies for ocular surface squamous neoplasia (OSSN), ranging from surgical excision to empiric topical interferon alpha-2b (IFN-a2b). Methods: A decision model was constructed to determine which of 4 treatment strategies minimized expected persistence/recurrence of disease in patients with OSSN: excision followed by repeat excision for positive surgical margins, excision followed by IFN-a2b for positive margins, incisional biopsy followed by IFN-a2b for positive biopsies, and empiric treatment with IFN-a2b. Probabilities were estimated from literature published between 1983 and 2015. Expected values for the probability of recurrence could range from 0 (no persistence/recurrence) to 1 (persistence/recurrence). Sensitivity analyses were performed for each variable.Results: Excision followed by IFN-a2b for positive margins was estimated to minimize persistence/recurrence of OSSN (expected value 0.13 versus 0.17 for empiric IFN-a2b, 0.22 for excision-only, and 0.30 for incisional biopsy-directed IFN-a2b). The optimal strategy was sensitive to 3 variables: efficacy of IFN-a2b, recurrence after negative surgical margins, and accuracy of excisional biopsy. Conclusions: In our decision analysis using studies published between 1983 and 2015, surgical excision followed by IFN-a2b for positive margins is the favored strategy for minimizing persistence/ recurrence of OSSN. Future prospective studies would add to the certainty of these conclusions.

AB - Purpose: To compare treatment strategies for ocular surface squamous neoplasia (OSSN), ranging from surgical excision to empiric topical interferon alpha-2b (IFN-a2b). Methods: A decision model was constructed to determine which of 4 treatment strategies minimized expected persistence/recurrence of disease in patients with OSSN: excision followed by repeat excision for positive surgical margins, excision followed by IFN-a2b for positive margins, incisional biopsy followed by IFN-a2b for positive biopsies, and empiric treatment with IFN-a2b. Probabilities were estimated from literature published between 1983 and 2015. Expected values for the probability of recurrence could range from 0 (no persistence/recurrence) to 1 (persistence/recurrence). Sensitivity analyses were performed for each variable.Results: Excision followed by IFN-a2b for positive margins was estimated to minimize persistence/recurrence of OSSN (expected value 0.13 versus 0.17 for empiric IFN-a2b, 0.22 for excision-only, and 0.30 for incisional biopsy-directed IFN-a2b). The optimal strategy was sensitive to 3 variables: efficacy of IFN-a2b, recurrence after negative surgical margins, and accuracy of excisional biopsy. Conclusions: In our decision analysis using studies published between 1983 and 2015, surgical excision followed by IFN-a2b for positive margins is the favored strategy for minimizing persistence/ recurrence of OSSN. Future prospective studies would add to the certainty of these conclusions.

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