皮肤鳞状细胞癌临床病理特征及术后复发的相关因素分析  

Clinicopathological features and related factors of postoperative recurrence of cutaneous squamous cell carcinoma

作　　者：唐洪波 马庆宇 罗东[1] 康晓静[1] 梁俊琴[1] Tang Hongbo;Ma Qingyu;Luo Dong;Kang Xiaojing;Liang Junqin(Department of Dermatology,the People′s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Key Laboratory of Dermatology Research,Urumqi 830002,China)

机构地区：[1]新疆维吾尔自治区人民医院皮肤性病科,新疆皮肤病研究重点实验室,乌鲁木齐830002

出　　处：《中国医师杂志》2021年第6期826-830,共5页Journal of Chinese Physician

基　　金：国家自然科学基金(81760494)。

摘　　要：目的探讨皮肤鳞状细胞癌(CSCC)患者的临床病理特征,分析其复发的相关因素。方法收集2008年—2019年经新疆维吾尔自治区人民医院皮肤科、整形外科、烧伤科及口腔颌面外科组织病理诊断为CSCC的279例手术患者的临床及病理资料,按术后是否复发分为复发组(n=114)和未复发组(n=165),对其临床资料、病理特征等多个方面进行回顾性总结,采用单因素和多因素logistic分析CSCC复发的相关因素。结果279例CSCC手术患者中,男女比例约为1.82∶1;发病年龄(59.3±14.2)岁,年龄≥60岁的患者占比58.1%;发病病程平均24个月;暴露部位的发病率(88.2%)明显高于非暴露部位(11.8%);病理分化程度以高分化多见,为182例(65.2%);术后术区愈合良好244例(87.5%),愈合不良35例(12.5%);首次切缘病理阴性239例(85.7%),阳性40例(14.3%);确诊CSCC时发生淋巴结转移60例(21.5%),未发生淋巴结转移219例(78.5%)。单因素分析显示病程、发病部位、术后术区愈合情况、首次切缘病理情况,确诊时有无淋巴结转移与CSCC复发相关(P<0.05),经多因素logistic回归显示OR>1.6,此外,性别、年龄、皮损长径、术前皮损破溃情况、病理分化程度、辅助放疗等因素对CSCC复发的相关性尚不明确,差异均无统计学意义(P>0.05)。结论发病病程(≥20个月)、发病部位(头面暴露部位)、术后创面愈合情况(否)、首次切缘病理情况(阳性)及确诊时淋巴结转移状况(有转移)均为CSCC患者复发的危险因素。早期、准确的诊断对CSCC的预后和转归具有重要意义,尤其对有独立危险因素的患者早期行前哨淋巴结活检可早期发现转移、及时处理,从而改善CSCC患者的预后。Objective To investigate the clinicopathological features and factors related to recurrence in patients with cutaneous squamous cell carcinoma(CSCC).Methods The clinical and pathological data of 279 patients with CSCC diagnosed by histopathology in department of dermatology,plastic surgery,burns and oral and maxillofacial surgery of People′s Hospital of Xinjiang Uygur Autonomous Region from 2008 to 2019 were collected.They were divided into relapse group(n=114)and non relapse group(n=165)according to postoperative recurrence.Univariate and multivariate logistic analysis were used to analyze the related factors of CSCC recurrence.Results Among 279 patients with CSCC surgery,the ratio of male to female was about 1.82∶1;the average age of onset(59.3±14.2)years,age≥60 years(58.1%)was significantly higher;the average course of disease was 24 months;the incidence of exposed sites(88.2%)was significantly higher than that of non-exposed sites(11.8%);the degree of pathological differentiation was 182(65.2%)cases;postoperative wound healing:good 244 cases(87.5%),poor healing 35 cases(12.5%);first postoperative pathological margin:239(85.7%)negative and 40(14.3%)positive;60(21.5%)cases had lymph node metastasis occurred at the CSCC of diagnosis,and 219(78.5%)did not occur.Univariate analysis and multivariate logistic regression showed that the course of disease,the location of the disease,the healing of the postoperative area,the pathological condition of the first incision margin,and whether there was lymph node metastasis at the time of diagnosis were related to the recurrence of CSCC(OR all>1.6).In addition,the correlation between gender,age,lesion length,preoperative skin ulceration,pathological differentiation,adjuvant radiotherapy and other factors on the recurrence of CSCC was not clear,with no statistically significant difference(P>0.05).Conclusions The course of disease(≥20 months),the site of the disease(the exposed part of the head),the wound healing(poor),the pathological condition of the first margin(p

关 键 词：癌 鳞状细胞 皮肤肿瘤 复发 因素分析 

分 类 号：R739.5[医药卫生—肿瘤]