因服务中断导致皮肤鳞状细胞癌诊断延迟与更差的预后及改良手术方式相关。
Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches.
作者信息
Taccioli Filippo, Blessent Claudio Gio Francesco, Paganelli Alessia, Fagioli Francesca, Chester Johanna Mary, Kaleci Shaniko, Costantini Matteo, Ferrari Barbara, Fiorentini Chiara, De Santis Giorgio, Magnoni Cristina
机构信息
Department of Plastic Reconstructive and Aesthetic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy.
PhD Course in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy.
出版信息
Cancers (Basel). 2024 Apr 11;16(8):1469. doi: 10.3390/cancers16081469.
BACKGROUND
The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined.
OBJECTIVE
To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018-2019) with the phase following the pandemic's second wave (2021-2022).
METHODS
An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data.
RESULTS
More cSCC lesions were excised prior to the interruption of services ( = 312 vs. = 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm; = 0.006) and more invasive (52% vs. 89%; < 0.001), in the period 2021-2022. Surgical reconstructive techniques were significantly different ( = 0.001). Metastatic involvement was confirmed in three subjects (one in 2018-2019 and two in 2021-2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55-8.16, < 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09-3.88, = 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44-7.17, = 0.004).
CONCLUSIONS
Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.
背景
皮肤肿瘤的延迟诊断与预后恶化相关。在新冠疫情封锁期间，临床和外科医疗服务中断对多种疾病的影响已有文献记载。延迟诊断对皮肤鳞状细胞癌（cSCC）患者的影响尚不明确。
目的
比较在疫情导致服务暂停之前（2018 - 2019年）与疫情第二波之后（2021 - 2022年）切除的cSCC患者及病变特征和手术治疗情况。
方法
进行了一项为期两年的对416例手术切除的cSCC的观察性、单中心横断面研究。仅纳入组织学确诊为cSCC的患者。数据收集包括患者人口统计学和病变特征、手术时间、手术方式及组织学数据。
结果
在服务中断之前切除的cSCC病变更多（312例对186例）。在2021 - 2022年期间，病变显著更大（1.7±1.2厘米对2.1±1.5厘米；P = 0.006）且侵袭性更强（52%对89%；P < 0.001）。手术重建技术有显著差异（P = 0.001）。3例患者确诊有转移（2018 - 2019年1例，2021 - 2022年2例）。手术时间或患者特征无显著差异。多变量回归分析显示肿瘤侵袭风险高4.7倍（OR 4.69，95%CI 2.55 - 8.16，P < 0.001），真皮表皮移植几率高2倍（OR 2.06，95%CI 1.09 - 3.88，P = 0.025），手术切缘阳性风险高3.2倍（OR 3.21，95%CI 1.44 - 7.17，P = 0.004）。
结论
与疫情前相比，因患者获得临床和诊断服务减少导致的皮肤SCC诊断延迟与侵袭更严重的风险增加4.7倍、手术切缘阳性风险增加3倍以及对手术治疗有显著影响相关。患者队列特征和手术时间保持可比且无变化。
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