Chren Mary-Margaret, Sahay Anju P, Bertenthal Daniel S, Sen Saunak, Landefeld C Seth
Dermatology Service, San Francisco Veterans Affairs Medical Center and the Department of Veterans Affairs, San Francisco, California 94121, USA.
J Invest Dermatol. 2007 Jun;127(6):1351-7. doi: 10.1038/sj.jid.5700740. Epub 2007 Feb 15.
Quality of life is an important treatment outcome for conditions that are rarely fatal, such as cutaneous basal cell carcinoma and squamous cell carcinoma (typically called nonmelanoma skin cancer (NMSC)). The purpose of this study was to compare quality-of-life outcomes of treatments for NMSC. We performed a prospective cohort study of 633 consecutive patients with NMSC diagnosed in 1999 and 2000 and followed for 2 years after treatment at a university-based private practice or a Veterans Affairs clinic. The main outcome was tumor-related quality of life 1 to 2 years after therapy, measured with the 16-item version of Skindex, a validated measure. Skindex scores vary from 0 (best) to 100 (worst) in three domains: Symptoms, Emotions, and Function. Treatments were electrodessication and curettage (ED&C) in 21%, surgical excision in 40%, and Mohs surgery in 39%. Five hundred and eight patients (80%) responded after treatment. Patients treated with excision or Mohs surgery improved in all quality-of-life domains, but quality of life did not improve after ED&C. There was no difference in the amount of improvement after excision or Mohs surgery. For example, mean Skindex Symptom scores improved 9.7 (95% CI: 6.9, 12.5) after excision, 10.2 (7.4, 12.9) after Mohs surgery, and 3.4 (-0.9, 7.6) after ED&C. We conclude that, for NMSC, quality-of-life outcomes were similar after excision and Mohs surgery, and both therapies had better outcomes than ED&C.
对于诸如皮肤基底细胞癌和鳞状细胞癌（通常称为非黑色素瘤皮肤癌（NMSC））这类极少致命的疾病，生活质量是一项重要的治疗结果。本研究的目的是比较NMSC治疗后的生活质量结果。我们对1999年和2000年确诊的633例连续性NMSC患者进行了一项前瞻性队列研究，并在一家大学附属私人诊所或退伍军人事务诊所接受治疗后随访2年。主要结果是治疗后1至2年与肿瘤相关的生活质量，采用经过验证的16项版Skindex进行测量。Skindex评分在症状、情绪和功能三个领域从0（最佳）到100（最差）不等。治疗方法包括21%的电干燥刮除术（ED&C）、40%的手术切除和39%的莫氏手术。508例患者（80%）治疗后有反应。接受切除或莫氏手术治疗的患者在所有生活质量领域均有改善，但ED&C治疗后生活质量未改善。切除或莫氏手术后的改善程度没有差异。例如，切除术后Skindex症状平均评分改善9.7（95%CI：6.9，12.5），莫氏手术后改善10.2（7.4，12.9），ED&C治疗后改善3.4（-0.9，7.6）。我们得出结论，对于NMSC，切除和莫氏手术后的生活质量结果相似，且两种治疗方法的结果均优于ED&C。
