验证2022年全国综合癌症网络对皮肤状细胞癌的风险分层
Jacqueline S Stevens1, Fadi Murad1, Timothy D Smile2
1Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA dermatology
|June 7, 2023
概括
国家综合癌症网络 (NCCN) 的风险组有效地识别高风险的皮肤状细胞癌 (CSCC). 莫斯微图外科手术 (Mohs) 或外围和深部面部边缘评估 (PDEMA) 显示在CSCC治疗中比宽局部切除 (WLE) 有更好的结果.
科学领域:
- 在瘤学瘤学.
- 皮肤病学 皮肤病学
- 手术瘤学手术瘤学
背景情况:
- 2022年国家综合癌症网络 (NCCN) 的指导方针将皮肤状细胞癌 (CSCC) 重归类为低风险,高风险和非常高风险组.
- 对于高风险和非常高风险的CSCC,建议进行莫斯微图手术 (Mohs) 或外围和深部面部边缘评估 (PDEMA).
- 需要验证这种新的风险分层和治疗建议.
研究的目的:
- 为了比较CSCC分层成NCCN低风险,高风险和非常高风险组的结果.
- 为了比较用莫斯或PDEMA治疗的CSCC与广泛局部切除 (WLE) 的结果.
主要方法:
- 追溯队列研究,包括1996年至2019年期间诊断的8727名患者 (18岁或以上) 的10,196个CSCC瘤.
- 患者在两个高等学术医疗中心接受治疗.
- 分析的结果包括局部复发 (LR),结节转移 (NM),远程转移 (DM) 和疾病特异性死亡 (DSD).
主要成果:
- 与低风险组相比,高风险和非常高风险的CSCCs显著增加了LR,NM,DM和DSD的风险.
- 五年累计的LR,NM,DM和DSD发病率在非常高风险组明显高于高风险和低风险组.
- 接受莫斯或PDEMA治疗的CSCC与WLE治疗的患者相比,患LR,DM和DSD的风险较低.
结论:
- NCCN风险分层有效地识别出具有较高不良结果风险的CSCC.
- 与WLE相比,Mohs或PDEMA在减少局部复发,远程转移和疾病特异性死亡方面表现出优异的结果.
- 这些发现支持NCCN风险分层和Mohs或PDEMA用于高风险和非常高风险的CSCC.
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