Askari Morad, Kakar Sanjeev, Moran Steven L
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Department of Surgery, Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN.
J Hand Surg Am. 2013 Nov;38(11):2124-33. doi: 10.1016/j.jhsa.2013.08.090. Epub 2013 Sep 17.
Squamous cell carcinoma (SCC) is a common malignancy of the hand; yet, recurrence rates, metastatic rates, and long-term survival rates have not been well defined. This study evaluated the risk factors for local and regional recurrence for this diagnosis.
Records of patients treated for SCC of the hand over a 20-year period in a single institution were reviewed. Data collected included patient demographics, tumor characteristics, and preoperative and postoperative care received. Overall survival, recurrence-free survival, and survival free of SCC in the same upper extremity were analyzed.
A total of 86 patients were identified. Mean age at the time of initial presentation was 69 years (range, 39-89 y). Mean follow-up was 6.4 years (range, 1-15 y). Overall survival was 88% and 57% at 5 and 10 years, respectively. Recurrence-free survival was 67% and 50% at 5 and 10 years, respectively. Rate of metastasis was 4%. Lymph node biopsy was performed in 4 patients who had clinical lymphadenopathy; 2 patients had positive nodes. Average time to first recurrence was 4.1 years (range, 0.5-11 y). Web space location, bilateral tumors, multiple tumors, and prior history of SCC were associated with an increased risk of recurrence. Survival free of SCC in the same upper extremity was 72% and 54% at 5 and 10 years, respectively. Younger age, history of transplantation, multiple tumors, and use of flap or skin graft for closure were associated with an increased risk of another SCC developing in the same extremity. No benefit was noted with wide, Mohs, or shave resection in terms of overall survival, recurrence-free survival, or SCC occurrence in the ipsilateral upper extremity.
Squamous cell carcinoma tumors of the hand have a high tendency for local recurrence but a low rate of metastasis. Specific characteristics of the tumor may increase chances of recurrence. The technique of tumor excision did not have a major role in outcome.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
鳞状细胞癌（SCC）是手部常见的恶性肿瘤；然而，其复发率、转移率和长期生存率尚未得到明确界定。本研究评估了该诊断的局部和区域复发危险因素。
回顾了在单一机构接受手部SCC治疗的患者20年期间的记录。收集的数据包括患者人口统计学、肿瘤特征以及术前和术后接受的护理。分析了总生存率、无复发生存率以及同一上肢无SCC生存率。
共确定了86例患者。初次就诊时的平均年龄为69岁（范围39 - 89岁）。平均随访时间为6.4年（范围1 - 15年）。5年和10年时的总生存率分别为88%和57%。5年和10年时的无复发生存率分别为67%和50%。转移率为4%。对4例有临床淋巴结肿大的患者进行了淋巴结活检；2例患者淋巴结阳性。首次复发的平均时间为4.1年（范围0.5 - 11年）。指蹼间隙部位、双侧肿瘤、多发肿瘤以及既往SCC病史与复发风险增加相关。同一上肢无SCC生存率在5年和10年时分别为72%和54%。年龄较小、移植史、多发肿瘤以及使用皮瓣或植皮进行闭合与同一上肢发生另一个SCC的风险增加相关。在总生存率、无复发生存率或同侧上肢SCC发生方面，广泛切除、Mohs切除或削除切除均未显示出益处。
手部鳞状细胞癌肿瘤局部复发倾向高但转移率低。肿瘤的特定特征可能增加复发几率。肿瘤切除技术对结果没有主要影响。
研究类型/证据水平：预后性IV级
