广泛的围神经入侵与神经口径,以评估皮肤状细胞癌预后
Paul R Massey1, David M Wang2, Fadi Murad2
1Cheyenne Skin Clinic, Cheyenne, Wyoming.
JAMA dermatology
|October 18, 2023
概括
广泛的周围神经侵袭 (ePNI),定义为涉及5个或更多的神经,是皮肤状细胞癌 (CSCC) 糟糕结果的重要预测因素. 这一发现支持ePNI.
科学领域:
- 在瘤学瘤学.
- 病理学 病理学 病理学
- 皮肤病学 皮肤病学
背景情况:
- 围神经侵入 (PNI) 是皮肤状细胞癌 (CSCC) 的关键预后因素.
- 有限的研究存在,比较不同的PNI模式及其对患者结果的影响.
- 准确评估PNI对于疾病管理和预后至关重要.
研究的目的:
- 为了比较四个不同的PNI评估在CSCC.
- 评估这些PNI评估与患者不良结果的关联.
- 确定PNI评估对布里格姆和妇女医院 (BWH) 阶段系统的影响.
主要方法:
- 140名患有初级,局部,侵入性CSCC和PNI的患者进行了回顾性队列研究.
- 四个PNI评估的比较:神经口径,涉及的神经的数量,PNI深度和PNI位置.
- 病理幻灯片的二次审查和临床结果的抽象.
- 多变量竞争风险回归和接收机操作特征曲线分析.
主要成果:
- 多个神经的参与与CSCC的不良结果有关.
- 广泛的PNI (ePNI),定义为5个或更多的涉及神经,独立预测局部复发,疾病特异性死亡和复合差异.
- 与使用神经口径的当前系统相比,采用ePNI的修订后的BWH分期系统显示出更好的预后准确性.
结论:
- 广泛的PNI (ePNI) 是在CSCC中评估的PNI模式中最重要的预后指标.
- ePNI在神经口径上提供了优越的预后能力,并且不需要微米.
- 将ePNI纳入CSCC分期系统可以提高患者风险分层并指导治疗决策.
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