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Mohs 显微外科手术与广泛局部切除术治疗眼睑皮脂腺腺癌：国家数据库分析。

Mohs micrographic surgery versus wide local excision for sebaceous adenocarcinoma of the eyelid : Analysis of a national database.

机构信息

Department of Dermatology, Liverpool Hospital, Elizabeth St, Sydney, NSW 2170, Australia; Southwest Sydney Clinical School, University of New South Wales (UNSW), Sydney, Australia.

Baylor College of Medicine, Houston, Texas, United States.

出版信息

J Plast Reconstr Aesthet Surg. 2019 Jun;72(6):1007-1011. doi: 10.1016/j.bjps.2019.02.009. Epub 2019 Mar 2.

DOI:10.1016/j.bjps.2019.02.009

PMID:30894313

Abstract

BACKGROUND

Sebaceous adenocarcinomas are rare and potentially aggressive tumors, which typically arise in the periocular region. Surgical treatments for eyelid sebaceous adenocarcinomas include Mohs micrographic surgery (MMS) and wide local excision (WLE). The objective of this study was to compare long-term survival outcomes of MMS versus WLE techniques for eyelid sebaceous adenocarcinomas.

METHODS

A retrospective analysis was performed using data obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registry database. We analyzed cases diagnosed from 1998 to 2015 within the database. Patients diagnosed with sebaceous adenocarcinoma were identified using ICD codes. Cases were limited to primary sebaceous adenocarcinomas involving specifically the eyelid region. The main outcomes were assessed by Kaplan-Meier (KM) survival and Cox proportional hazards model.

RESULTS

Sixty-seven cases of MMS were compared with 114 cases of WLE for eyelid sebaceous carcinoma. Overall KM survival rates for MMS compared to WLE at 5-year (75.6% vs. 70.3%) and 10-year follow-up (69.2% vs. 46.9%) did not show significant difference by logrank (P = 0.062). Similarly, after adjusting for demographic, tumor, and treatment characteristics, there was no significant difference in cancer-specific survival (HR 0.45, 95% CI 0.03-6.92, P = 0.57) and overall survival (HR 0.94, 95% CI 0.50-1.74, P = 0.83) when MMS surgical technique was compared with WLE techniques.

CONCLUSIONS

Our adjusted analyses demonstrated no differences in overall survival or cancer-adjusted survival for patients with eyelid sebaceous adenocarcinomas treated with MMS compared with WLE. In areas requiring preservation of tissue because of cosmetic or functional purposes, MMS is a reasonable surgical approach.

摘要

背景

皮脂腺腺癌是一种罕见且具有潜在侵袭性的肿瘤，通常发生在眼周区域。眼睑皮脂腺腺癌的外科治疗包括莫氏显微手术（Mohs micrographic surgery，MMS）和广泛局部切除术（wide local excision，WLE）。本研究旨在比较 MMS 与 WLE 技术治疗眼睑皮脂腺腺癌的长期生存结果。

方法

使用来自监测、流行病学和最终结果（Surveillance, Epidemiology, and End Results，SEER）癌症登记数据库的数据进行回顾性分析。我们分析了数据库中 1998 年至 2015 年期间诊断的病例。使用国际疾病分类（International Classification of Diseases，ICD）代码识别诊断为皮脂腺腺癌的病例。病例仅限于特定涉及眼睑区域的原发性皮脂腺腺癌。主要结局通过 Kaplan-Meier（KM）生存和 Cox 比例风险模型进行评估。

结果

将 67 例 MMS 与 114 例 WLE 治疗眼睑皮脂腺癌进行比较。MMS 与 WLE 的 5 年（75.6%比 70.3%）和 10 年（69.2%比 46.9%）KM 总生存率差异无统计学意义（对数秩检验，P=0.062）。同样，在调整了人口统计学、肿瘤和治疗特征后，MMS 手术技术与 WLE 技术相比，在癌症特异性生存（HR 0.45，95%CI 0.03-6.92，P=0.57）和总生存（HR 0.94，95%CI 0.50-1.74，P=0.83）方面无显著差异。