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眼表鳞状细胞肿瘤:2003 年至 2022 年护理标准的变化。

Ocular Surface Squamous Neoplasia: Changes in the Standard of Care 2003 to 2022.

机构信息

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.

Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL.

出版信息

Cornea. 2024 Aug 1;43(8):942-949. doi: 10.1097/ICO.0000000000003461. Epub 2024 Jan 18.

Abstract

PURPOSE

The aim of this review was to elucidate treatment preferences for ocular surface squamous neoplasia and to examine the changes in treatment modalities over the past 2 decades.

METHODS

An electronic survey was distributed to members of The Cornea Society, Ocular Microbiology and Immunology Group, and 4 international corneal specialist listservs. Questions examined medical and surgical treatment preferences, and results were compared with surveys administered in 2003 and 2012.

RESULTS

A total of 285 individuals responded to the survey; 90% of respondents were self-classified as corneal specialists. Seventy-three percent reported using primary topical monotherapy to treat ocular surface squamous neoplasia as compared with 58% in 2012 ( P = 0.008). Compared with 2003, the percentage use of topical interferon significantly increased ( P < 0.0001) from 14% to 55%, 5-fluorouracil increased ( P < 0.0001) from 5% to 23%, and mitomycin C decreased ( P < 0.0001) from 76% to 19% as a primary monotherapy. The frequency of performing excision without the use of postoperative adjunctive medical therapy decreased significantly ( P < 0.0001), from 66% to 26% for lesions <2 mm, 64% to 12% for lesions between 2 and 8 mm, and 47% to 5% for lesions >8 mm from 2003 to 2022. More clinicians initiated topical immuno/chemotherapy without performing a biopsy as compared to 2003 (31% vs. 11%, P < 0.0001).

CONCLUSIONS

These results demonstrate a paradigm shift in the management of ocular surface squamous neoplasia. The use of primary medical therapy as a first approach has significantly increased, with a reduction in the frequency of performing surgical excision alone.

摘要

目的

本综述旨在阐明眼表鳞状细胞癌的治疗偏好,并检查过去 20 年治疗方式的变化。

方法

向角膜学会、眼微生物学和免疫学组以及 4 个国际角膜专家名录组的成员分发了一份电子调查。调查询问了医学和手术治疗偏好,结果与 2003 年和 2012 年进行的调查进行了比较。

结果

共有 285 人对调查做出了回应;90%的应答者自我归类为角膜专家。与 2012 年的 58%相比,73%的人报告使用主要局部单一疗法治疗眼表鳞状细胞癌(P=0.008)。与 2003 年相比,局部干扰素的使用比例显著增加(P<0.0001),从 14%增加到 55%,5-氟尿嘧啶增加(P<0.0001),从 5%增加到 23%,丝裂霉素 C 减少(P<0.0001),从 76%减少到 19%,作为单一主要疗法。不使用术后辅助药物治疗而进行切除术的频率显著下降(P<0.0001),对于<2mm 的病变,从 2003 年的 66%降至 2022 年的 26%,对于 2-8mm 的病变,从 64%降至 12%,对于>8mm 的病变,从 47%降至 5%。与 2003 年相比,更多的临床医生在未进行活检的情况下开始进行局部免疫/化学疗法(31%对 11%,P<0.0001)。

结论

这些结果表明眼表鳞状细胞癌的治疗模式发生了转变。作为初始方法的主要药物治疗的使用显著增加,单独进行手术切除的频率降低。

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