Mohs 显微外科治疗眼睑皮脂腺癌：一项多中心队列研究 360 例患者。

Mohs micrographic surgery for eyelid sebaceous carcinoma: A multicenter cohort of 360 patients.

机构信息

Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.

Department of Ophthalmology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.

出版信息

J Am Acad Dermatol. 2019 Jun;80(6):1608-1617.e1. doi: 10.1016/j.jaad.2018.12.053. Epub 2019 Jan 9.

DOI:10.1016/j.jaad.2018.12.053

PMID:30639290

Abstract

BACKGROUND

The decision to perform Mohs micrographic surgery (MMS) or wide local excision (WLE) for eyelid sebaceous carcinoma (SC) is controversial.

OBJECTIVE

To compare local recurrence, metastasis, and tumor-related mortality of patients with eyelid SC who were initially treated with MMS versus with WLE.

METHODS

A multicenter cohort study. Medical records were reviewed for factors associated with recurrence, metastasis, and tumor-related mortality. All eligible patients were followed up. The impact of initial surgical modality on the prognoses were determined by Cox analyses after control for all confounders.

RESULTS

Of the 360 patients included in this cohort, 115 (31.9%) underwent MMS as primary resection, whereas 245 (68.1%) underwent WLE. After a median follow-up period of 60.0 months, local recurrence was observed in 18 patients (15.7%) in the MMS group and 97 patients (39.6%) in the WLE group. Metastasis occurred in 9 patients (7.8%) who underwent MMS and 38 (15.5%) who underwent WLE. In all, 6 patients in the MMS group (5.2%) and 21 in the WLE group (8.6%) died of metastatic SC. Multivariable Cox regression indicated that compared with the WLE group, the MMS group exhibited more favorable local recurrence control (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.24-0.73; P = .002) but a comparable metastasis rate (HR, 1.38; 95% CI, 0.60-3.18; P = .453) and comparable tumor-related mortality (HR, 1.70; 95% CI, 0.59-4.93; P = .329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR, 1.73; 95% CI, 0.37-8.21; P = .488).

LIMITATIONS

Retrospective nature of the study.

CONCLUSION

MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control; however, this surgical procedure did not change the long-term outcomes in terms of metastasis or tumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.

摘要

背景

对于眼睑皮脂癌（SC），行 Mohs 显微外科手术（MMS）或广泛局部切除术（WLE）的决策存在争议。

目的

比较眼睑 SC 患者初始接受 MMS 与 WLE 治疗后的局部复发、转移和肿瘤相关死亡率。

方法

一项多中心队列研究。对与复发、转移和肿瘤相关死亡相关的因素进行回顾性病历分析。所有符合条件的患者均进行随访。通过 Cox 分析，在控制所有混杂因素后，确定初始手术方式对预后的影响。

结果

在纳入的 360 例患者中，115 例（31.9%）患者作为初次切除术接受 MMS，245 例（68.1%）患者接受 WLE。中位随访 60.0 个月后，MMS 组 18 例（15.7%）患者和 WLE 组 97 例（39.6%）患者出现局部复发。MMS 组发生转移 9 例（7.8%），WLE 组转移 38 例（15.5%）。MMS 组共有 6 例（5.2%）患者和 WLE 组 21 例（8.6%）患者因转移性 SC 死亡。多变量 Cox 回归分析表明，与 WLE 组相比，MMS 组具有更好的局部复发控制效果（风险比[HR]，0.42；95%置信区间[CI]，0.24-0.73；P=0.002），但转移率（HR，1.38；95% CI，0.60-3.18；P=0.453）和肿瘤相关死亡率（HR，1.70；95% CI，0.59-4.93；P=0.329）相当。然而，对于存在 paget 样上皮内瘤变的患者，这种有益效果变得不明显（HR，1.73；95% CI，0.37-8.21；P=0.488）。