Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Dermatol Ther. 2020 Nov;33(6):e13991. doi: 10.1111/dth.13991. Epub 2020 Aug 6.
The optimal surgical management of sebaceous carcinoma (SC) has yet to be determined between Mohs micrographic surgery (MMS) and wide local excision (WLE). To investigate overall survival (OS) differences for SC undergoing WLE or MMS, The National Cancer Database (NCDB) was queried for all SC from 2004 to 2015 (n = 2863). Cases missing staging data, undergoing palliative care, showing lymph node extension, or of AJCC Stage III/IV were omitted. Chi-squared tests were used to analyze patient demographics, cancer characteristics, and treatment modalities. Kaplan-Meier and Cox proportional hazards regression modeling analyzed OS outcomes. A total of 554 cases met inclusion criteria (WLE [n = 243], MMS [n = 311]). Multivariate analysis revealed that cases treated in academic facilities (ref: non-acad; OR = 2.273; CI95% [1.448-3.568]; P < .001] were independently associated with greater MMS rates, whereas those with primaries on the trunk (ref: head/neck OR = 0.359; CI95%[0.203-0.634]; P < .001) and extremities (ref: head/neck OR = 0.399; CI95% [0.182-0.877]; P = .022) held lower MMS rates. Between surgical modalities, Kaplan-Meier survival showed no significant difference in outcomes (P = .611), with WLE and MMS demonstrating 5-year OS rates of 65.8% and 61.4%, respectively. On Cox proportional hazard regression, the survival outcomes of MMS and WLE did not show any significant differences in OS (HR = 0.832; CI95% [0.996-3.662]; P = .334). MMS and WLE of localized SC demonstrate similar overall survival outcomes. MMS may be preferred for margin control, tissue conservation, and cosmesis.
皮脂腺癌（SC）的最佳手术治疗方法仍在Mohs 显微外科手术（MMS）和广泛局部切除（WLE）之间存在争议。为了研究接受 WLE 或 MMS 治疗的 SC 的总生存（OS）差异，国家癌症数据库（NCDB）从 2004 年至 2015 年对所有 SC 病例进行了查询（n=2863）。排除了分期数据缺失、接受姑息治疗、有淋巴结转移或 AJCC 分期 III/IV 的病例。使用卡方检验分析患者人口统计学、癌症特征和治疗方式。Kaplan-Meier 和 Cox 比例风险回归模型分析 OS 结果。共有 554 例符合纳入标准（WLE [n=243]，MMS [n=311]）。多变量分析显示，在学术机构接受治疗的病例（参考：非学术机构；OR=2.273；CI95%[1.448-3.568]；P<0.001）与更高的 MMS 率独立相关，而原发于躯干（参考：头颈部 OR=0.359；CI95%[0.203-0.634]；P<0.001）和四肢（参考：头颈部 OR=0.399；CI95%[0.182-0.877]；P=0.022）的病例 MMS 率较低。在手术方式之间，Kaplan-Meier 生存分析显示结果无显著差异（P=0.611），WLE 和 MMS 的 5 年 OS 率分别为 65.8%和 61.4%。在 Cox 比例风险回归中，MMS 和 WLE 的 OS 生存结果无显著差异（HR=0.832；CI95%[0.996-3.662]；P=0.334）。局限性 SC 的 MMS 和 WLE 显示出相似的总生存结果。MMS 可能更适合于切缘控制、组织保存和美容效果。
