Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Cancer. 2019 Oct 15;125(20):3582-3594. doi: 10.1002/cncr.32371. Epub 2019 Jul 29.
The objective of this study was to compare the cosmesis and recurrence rates of conventional excision (CE), Mohs micrographic surgery (MMS), external-beam radiation therapy (EBRT), or brachytherapy (BT), for basal cell carcinoma and squamous cell carcinoma of the skin.
Population, Intervention, Control, Outcome, Study Design (PICOS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) methods were used to identify studies on PubMed (from 1985 to 2018), including patients with American Joint Committee on Cancer (AJCC) T1-T2N0 basal cell carcinomas and squamous cell carcinomas and ≥10 months follow-up who received CE, MMS, EBRT, or BT. The primary endpoint was cosmesis, classified as "good," "fair," or "poor." The secondary endpoint was 1-year recurrence. Fixed-effects and random-effects meta-analyses were performed to evaluate primary and secondary outcomes with respect to treatment modality.
In total, 18,095 studies met initial search criteria. There were 24 CE, 13 MMS, 19 EBRT, and 7 BT studies included with a total of 21,371 patients. The summary effect size for "good" cosmesis was 81% (95% CI, 70.6%-89.6%), 74.6% (95% CI, 63%-84.6%), and 97.6% (95% CI, 91.3%-100%) for CE, EBRT, and BT, respectively. Good cosmesis was 96.0% in the only MMS study that reported cosmesis. BT had improved "good" cosmesis over EBRT (P = .0025) and was similar to CE and MMS. No significant differences were seen for "fair" or "poor" cosmesis. One-year recurrence rates were low throughout at 0.8% (95% CI, 0.3%-1.6%), 0.2% (95% CI, 0%-0.6%), 2% (95% CI, 1.3%-2.7%), and 0% (95% CI, 0%-0.5%) for CE, MMS, EBRT, and BT, respectively.
For T1-T2N0 skin cancers, BT and MMS have improved cosmesis over EBRT and CE. It is unclear whether this is because of treatment superiority or selection and reporting bias. Local control is similar among all modalities at 1 year.
本研究旨在比较传统切除术（CE）、Mohs 显微外科手术（MMS）、外照射放射治疗（EBRT）或近距离放射治疗（BT）治疗皮肤基底细胞癌和鳞状细胞癌的美容效果和复发率。
采用人群、干预、对照、结局、研究设计（PICOS）、系统评价和荟萃分析首选报告项目（PRISMA）和观察性研究荟萃分析流行病学（MOOSE）方法，在 PubMed 上检索 1985 年至 2018 年的研究，包括接受 CE、MMS、EBRT 或 BT 治疗、美国癌症联合委员会（AJCC）T1-T2N0 基底细胞癌和鳞状细胞癌且随访时间≥10 个月的患者。主要终点为美容效果，分为“良好”、“一般”或“差”。次要终点为 1 年复发率。采用固定效应和随机效应荟萃分析评估治疗方式对主要和次要结局的影响。
共检索到 18095 项初始检索结果，纳入 24 项 CE 研究、13 项 MMS 研究、19 项 EBRT 研究和 7 项 BT 研究，共纳入 21371 例患者。CE、EBRT 和 BT 治疗的“良好”美容效果的汇总效应大小分别为 81%（95%CI，70.6%-89.6%）、74.6%（95%CI，63%-84.6%）和 97.6%（95%CI，91.3%-100%）。唯一报告美容效果的 MMS 研究中，BT 的“良好”美容效果为 96.0%。BT 的“良好”美容效果优于 EBRT（P=0.0025），与 CE 和 MMS 相似。“一般”或“差”美容效果无显著差异。1 年复发率均较低，CE、MMS、EBRT 和 BT 治疗的复发率分别为 0.8%（95%CI，0.3%-1.6%）、0.2%（95%CI，0%-0.6%）、2%（95%CI，1.3%-2.7%）和 0%（95%CI，0%-0.5%）。
对于 T1-T2N0 皮肤癌，BT 和 MMS 的美容效果优于 EBRT 和 CE。尚不清楚这是因为治疗效果更好还是因为选择和报告偏倚。所有治疗方法在 1 年时的局部控制率相似。
