Brinkman Jacobus Nick, Hajder Edin, van der Holt Bronno, Den Bakker Michael A, Hovius Steven E R, Mureau Marc A M
From the Departments of *Plastic and Reconstructive Surgery, †Trials and Statistics, and ‡Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Ann Plast Surg. 2015 Sep;75(3):323-6. doi: 10.1097/SAP.0000000000000110.
The incidence of cutaneous squamous cell carcinoma (SCC) is increasing worldwide. Despite a growing body of literature on prognostic factors, it remains unclear how tumor differentiation grade influences patient survival. The aim of this study was to investigate a possible correlation between cutaneous SCC differentiation, local recurrence, metastasis, and patient survival.
All consecutive patients treated for cutaneous SCC between 2001 and 2008 were retrospectively analyzed. Univariate survival analysis was used to assess the association of different tumor characteristics with survival.
One hundred thirty-one patients with 155 SCCs were included (median follow-up, 81 months; range, 27-125 months). Although no significant correlation between tumor differentiation grade and local recurrence could be found, it was an independent prognostic factor for metastatic disease and overall survival (OS). Metastasis-free survival at 5 years was significantly higher in well-differentiated tumors (70%) compared to moderately (51%) and poorly differentiated SCCs (26%; P = 0.012); identical percentages were found for OS (P = 0.005). Furthermore, patients with incomplete excision of the first tumor showed an increased relative risk of dying of SCC of 4.0 (95% confidence interval, 2.4-6.6; P < 0.001) compared to excision with clear margins.
Studies that investigated the relationship between SCC differentiation grade and patient survival are scarce and inconsistent. The present study indicates tumor differentiation grade is an independent prognostic factor for OS. This finding suggests poor differentiation of cutaneous SCC alone is sufficient to upstage the primary tumor in the TNM classification system.
皮肤鳞状细胞癌（SCC）的发病率在全球范围内呈上升趋势。尽管关于预后因素的文献越来越多，但肿瘤分化程度如何影响患者生存仍不清楚。本研究的目的是探讨皮肤SCC分化、局部复发、转移与患者生存之间的可能相关性。
回顾性分析2001年至2008年间所有连续治疗的皮肤SCC患者。采用单因素生存分析评估不同肿瘤特征与生存的相关性。
纳入131例患者的155个SCC（中位随访时间81个月；范围27 - 125个月）。虽然未发现肿瘤分化程度与局部复发之间存在显著相关性，但它是转移性疾病和总生存（OS）的独立预后因素。高分化肿瘤5年无转移生存率（70%）显著高于中分化（51%）和低分化SCC（26%；P = 0.012）；OS的百分比相同（P = 0.005）。此外，与切缘阴性切除相比，首次肿瘤切除不完全的患者死于SCC的相对风险增加4.0（95%置信区间，2.4 - 6.6；P < 0.001）。
研究SCC分化程度与患者生存关系的研究较少且结果不一致。本研究表明肿瘤分化程度是OS的独立预后因素。这一发现表明，仅皮肤SCC的低分化就足以在TNM分类系统中使原发性肿瘤分期升高。
