慢性淋巴细胞白血病患者在莫氏手术后鳞状细胞癌的高复发率。
High recurrence rates of squamous cell carcinoma after Mohs' surgery in patients with chronic lymphocytic leukemia.
作者信息
Mehrany Khosrow, Weenig Roger H, Pittelkow Mark R, Roenigk Randall K, Otley Clark C
机构信息
Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
出版信息
Dermatol Surg. 2005 Jan;31(1):38-42; discussion 42. doi: 10.1111/j.1524-4725.2005.31006.
BACKGROUND
Cutaneous cancers exhibit a much higher incidence in patients with chronic lymphocytic leukemia than in nonleukemic patients. Squamous and basal cell carcinomas also exhibit greater subclinical tumor extension in patients with chronic lymphocytic leukemia.
OBJECTIVE
The purpose of this study was to estimate and compare the recurrence rates of squamous cell carcinoma after Mohs' surgery in patients with chronic lymphocytic leukemia compared with those in controls and to evaluate differences among squamous cell carcinoma size and histologic grade.
METHODS
We retrospectively assessed the clinical histories, postoperative notes, and surgical photographs of patients with chronic lymphocytic leukemia and controls matched (2:1) for age, sex, and surgical year. Both patients and controls underwent Mohs' surgery for squamous cell carcinoma of the head and neck at the Mayo Clinic between March 1988 and April 1999.
RESULTS
Twenty-eight patients who underwent Mohs' surgery for 57 squamous cell carcinomas had 7 recurrences. The cumulative incidence of recurrence on a per-tumor basis was 4.3% at 1 year, 14.8% at 3 years, and 19.0% at 5 years. Squamous cell carcinoma was seven times more likely to recur in patients with chronic lymphocytic leukemia than in controls (p = .003). The distribution of tumor histologic grade was not significantly different between patients and controls (p = .39). Maximum preoperative tumor diameters were clinically similar between patients and controls (median 15 mm vs 14 mm; p = .04).
CONCLUSION
The recurrence rates of squamous cell carcinoma were significantly higher in patients with chronic lymphocytic leukemia. Squamous cell carcinomas in patients with chronic lymphocytic leukemia did not exhibit a significant difference in histologic grade or clinical difference in preoperative tumor size. Close surveillance for squamous cell carcinoma recurrence is warranted in patients with chronic lymphocytic leukemia.
背景
与非白血病患者相比，慢性淋巴细胞白血病患者的皮肤癌发病率要高得多。鳞状细胞癌和基底细胞癌在慢性淋巴细胞白血病患者中也表现出更大的亚临床肿瘤扩展。
目的
本研究的目的是估计并比较慢性淋巴细胞白血病患者与对照组在Mohs手术治疗鳞状细胞癌后的复发率，并评估鳞状细胞癌大小和组织学分级之间的差异。
方法
我们回顾性评估了慢性淋巴细胞白血病患者和年龄、性别及手术年份相匹配（2:1）的对照组的临床病史、术后记录和手术照片。1988年3月至1999年4月期间，患者和对照组均在梅奥诊所接受了针对头颈部鳞状细胞癌的Mohs手术。
结果
28例接受Mohs手术治疗57例鳞状细胞癌的患者中有7例复发。基于肿瘤的复发累积发生率在1年时为4.3%，3年时为14.8%，5年时为19.0%。慢性淋巴细胞白血病患者的鳞状细胞癌复发可能性是对照组的7倍（p = .003）。患者和对照组之间肿瘤组织学分级的分布无显著差异（p = .39）。患者和对照组术前肿瘤最大直径在临床上相似（中位数分别为15 mm和14 mm；p = .04）。
结论
慢性淋巴细胞白血病患者的鳞状细胞癌复发率显著更高。慢性淋巴细胞白血病患者的鳞状细胞癌在组织学分级或术前肿瘤大小的临床差异方面无显著差异。对慢性淋巴细胞白血病患者进行鳞状细胞癌复发的密切监测是必要的。
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