1261例皮膚惡性腫瘤臨床流行病學(xué)和手術(shù)切緣分析
發(fā)布時(shí)間：2018-09-05 06:39
【摘要】：目的通過(guò)統(tǒng)計(jì)和分析中國(guó)醫(yī)學(xué)科學(xué)院皮膚病醫(yī)院皮膚外科住院診治的皮膚惡性腫瘤患者的基本臨床及病理資料,為了解皮膚惡性腫瘤的發(fā)病情況和變化趨勢(shì)提供線索。通過(guò)探討皮膚惡性腫瘤的手術(shù)切緣與復(fù)發(fā)和轉(zhuǎn)移的關(guān)系,推薦安全手術(shù)切緣與修復(fù)術(shù)式。方法采用1995年2月至2015年12月在我科確診的1261例皮膚惡性腫瘤患者臨床及病理資料進(jìn)行回顧性分析,所有統(tǒng)計(jì)學(xué)分析過(guò)程均通過(guò)SPSS19.0軟件完成。統(tǒng)計(jì)學(xué)方法主要包括t檢驗(yàn)、卡方檢驗(yàn)、Spearman相關(guān)分析、方差分析等。統(tǒng)計(jì)學(xué)方法P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果共統(tǒng)計(jì)皮膚惡性腫瘤患者1261例,其中男性750例(59.5%),女性511例(40.5%),男女比例有顯著性差異。其中EMPD患者男性比例最高,其次為SCC。皮膚惡性腫瘤患者平均年齡為(62.5±13.6)歲,高峰年齡均集中在40-80歲(86.4%)。男性患者年齡大于女性。從1995年至2015年,皮膚惡性腫瘤有明顯增加的趨勢(shì)。皮膚惡性腫瘤病例中基底細(xì)胞癌和鱗狀細(xì)胞癌數(shù)量較多,兩者合占總數(shù)的68.2%。從發(fā)病部位來(lái)看,BCC患者最常見(jiàn)于頭面部(90.0%),其中鼻部和顴頰部為主(65.7%)；SCC患者中,最常見(jiàn)于頭面部(52.4%)和會(huì)陰部(18.0%),頭面部中以顴頰部和頭皮(71.8%)為主。SCC中,發(fā)生在會(huì)陰部的性別構(gòu)成比存在差異,0-49歲和50歲以上患者發(fā)病部位構(gòu)成比差異有統(tǒng)計(jì)學(xué)意義。在手術(shù)治療的患者中,BCC患者腫瘤擴(kuò)切邊緣為0.3cm者與0.5cm者兩組邊緣陽(yáng)性率比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),0.5cm者與1.0cm者兩組邊緣陽(yáng)性率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05); SCC患者腫瘤切緣為0.5cm者與1.0cm者兩組切緣陽(yáng)性率比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),1.0cm者與1.5cm以上者兩組切緣陽(yáng)性率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 EMPD患者腫瘤切緣為1.0cm者與2.0cm者兩組切緣陽(yáng)性率比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。55例BCC與16例SCC患者行Mohs手術(shù),無(wú)復(fù)發(fā)。EMPD患者有效隨訪98例,平均隨訪(5.3±3.7)年,51例失訪,21例復(fù)發(fā),復(fù)發(fā)率21.4%。179例CMM患者中對(duì)31例進(jìn)行區(qū)域淋巴結(jié)活檢,總共13例陽(yáng)性,陽(yáng)性率41.9%。103例隨訪患者中,19例死亡,死亡率18.4%,其中13例死于惡性黑素瘤轉(zhuǎn)移,6例死于其它原因,5年生存率88.4%。采用區(qū)域淋巴結(jié)活檢有25例,其中轉(zhuǎn)移9例,轉(zhuǎn)移者死亡6人,5年生存率44.4%。隨訪的惡性黑素瘤中,有破潰者66例(64.1%),12例因該病死亡：無(wú)破潰者37例(35.9%),1例因該病死亡。破潰組與非破潰組死亡率有明顯統(tǒng)計(jì)學(xué)差異(矛=3.8,P0.05)。結(jié)論1、本院統(tǒng)計(jì)的皮膚惡性腫瘤男女比例有顯著性差異,男性患者比女性多,平均年齡為(62.5±13.6)歲,并呈增長(zhǎng)趨勢(shì)。男女患者平均就診年齡無(wú)差異,男性患者平均就診年齡為(62.6±13.3)歲,女性患者為(62.4±14.1)歲。2、BCC和SCC病例數(shù)量最多,與紫外線關(guān)系密切。SCC與紫外線的關(guān)系不如BCC密切,除曝光部位外SCC常發(fā)生于會(huì)陰部。會(huì)陰部SCC男性多于女性,49歲以下會(huì)陰部為主,50歲以上絕對(duì)曝光部位為主。CMM與紫外線關(guān)系不大,多數(shù)發(fā)生于肢端,尤其是足底。3、 Mohs手術(shù)為BCC與SCC手術(shù)金標(biāo)準(zhǔn),對(duì)于無(wú)條件行Mohs手術(shù)者,可按BCC 0.5cm, SCC 1.0cm作為手術(shù)安全邊緣。EMPD安全邊緣為2.0cm, CMM為2.0cm。4、CMM行區(qū)域淋巴結(jié)活檢,對(duì)于判斷分期預(yù)后有重要意義,皮損破潰者預(yù)后差。
[Abstract]:Objective To analyze the clinical and pathological data of patients with malignant skin tumors in Dermatology Hospital of Chinese Academy of Medical Sciences in order to provide clues for understanding the incidence and trend of skin tumors. Methods The clinical and pathological data of 1261 patients with malignant skin tumors diagnosed in our department from February 1995 to December 2015 were retrospectively analyzed. All the statistical analysis was performed by SPSS19.0 software. Results There were 1 261 cases of malignant skin tumors, 750 males (59.5%) and 511 females (40.5%). There was a significant difference in the proportion of males and females. From 1995 to 2015, there was a significant increase in the number of skin malignancies. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) accounted for 68.2% of the total number of skin malignancies. BCC patients were most common in the head and face (90.0%) from the location of the disease, including the nose and cheeks. Most of the SCC patients were in the head and face (52.4%) and perineal region (18.0%). Most of them were in the cheeks and cheeks and scalp (71.8%). There was no significant difference in the positive rate between 0.3 cm and 0.5 cm incision margins (P 0.05), 0.5 cm and 1.0 cm incision margins (P 0.05), and there was significant difference in the positive rate between 0.5 cm and 1.0 cm incision margins of SCC patients (P 0.05). There was no significant difference in the positive rate of incisional margin between the two groups (P 0.05). There was a significant difference in the positive rate of incisional margin between the two groups (P 0.05). There was no recurrence between the 55 BCC patients and 16 SCC patients. 98 EMPD patients were followed up effectively, with an average follow-up of (5.3 (+3.7) years, 51 lost, 21 relapsed, and the recurrence rate was 21.7%. Of the 179 patients with CMM, 31 had regional lymph node biopsy, with a positive rate of 41.9%. Of the 103 follow-up patients, 19 died, with a mortality rate of 18.4%. Of the 103 patients, 13 died of malignant melanoma metastasis, 6 died of other causes, and the 5-year survival rate was 88.4%. Of the 25 patients who had regional lymph node biopsy, 9 died of metastasis, 6 died of metastasis, and 5 years of survival. The survival rate was 44.4%. 66 cases (64.1%) of malignant melanoma were ulcerated and 12 cases died of the disease: 37 cases (35.9%) were non-ulcerated and 1 case died of the disease. There was significant difference in mortality between the ulcerated group and the non-ulcerated group (spear = 3.8, P 0.05). Conclusion 1. There was a significant difference in the proportion of male and female patients with malignant skin tumors. There was no difference in the average age of male and female patients. The average age of male patients was (62.6 + 13.3) years. The average age of female patients was (62.4 + 14.1) years. Perineal SCC is more common in men than in women. Perineal SCC is predominant in men under 49 years of age. Absolute exposure is predominant in women over 50 years of age. The safe margin of EMPD was 2.0 cm, CMM was 2.0 cm.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R739.5
，
本文編號(hào)：2223493
[Abstract]:Objective To analyze the clinical and pathological data of patients with malignant skin tumors in Dermatology Hospital of Chinese Academy of Medical Sciences in order to provide clues for understanding the incidence and trend of skin tumors. Methods The clinical and pathological data of 1261 patients with malignant skin tumors diagnosed in our department from February 1995 to December 2015 were retrospectively analyzed. All the statistical analysis was performed by SPSS19.0 software. Results There were 1 261 cases of malignant skin tumors, 750 males (59.5%) and 511 females (40.5%). There was a significant difference in the proportion of males and females. From 1995 to 2015, there was a significant increase in the number of skin malignancies. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) accounted for 68.2% of the total number of skin malignancies. BCC patients were most common in the head and face (90.0%) from the location of the disease, including the nose and cheeks. Most of the SCC patients were in the head and face (52.4%) and perineal region (18.0%). Most of them were in the cheeks and cheeks and scalp (71.8%). There was no significant difference in the positive rate between 0.3 cm and 0.5 cm incision margins (P 0.05), 0.5 cm and 1.0 cm incision margins (P 0.05), and there was significant difference in the positive rate between 0.5 cm and 1.0 cm incision margins of SCC patients (P 0.05). There was no significant difference in the positive rate of incisional margin between the two groups (P 0.05). There was a significant difference in the positive rate of incisional margin between the two groups (P 0.05). There was no recurrence between the 55 BCC patients and 16 SCC patients. 98 EMPD patients were followed up effectively, with an average follow-up of (5.3 (+3.7) years, 51 lost, 21 relapsed, and the recurrence rate was 21.7%. Of the 179 patients with CMM, 31 had regional lymph node biopsy, with a positive rate of 41.9%. Of the 103 follow-up patients, 19 died, with a mortality rate of 18.4%. Of the 103 patients, 13 died of malignant melanoma metastasis, 6 died of other causes, and the 5-year survival rate was 88.4%. Of the 25 patients who had regional lymph node biopsy, 9 died of metastasis, 6 died of metastasis, and 5 years of survival. The survival rate was 44.4%. 66 cases (64.1%) of malignant melanoma were ulcerated and 12 cases died of the disease: 37 cases (35.9%) were non-ulcerated and 1 case died of the disease. There was significant difference in mortality between the ulcerated group and the non-ulcerated group (spear = 3.8, P 0.05). Conclusion 1. There was a significant difference in the proportion of male and female patients with malignant skin tumors. There was no difference in the average age of male and female patients. The average age of male patients was (62.6 + 13.3) years. The average age of female patients was (62.4 + 14.1) years. Perineal SCC is more common in men than in women. Perineal SCC is predominant in men under 49 years of age. Absolute exposure is predominant in women over 50 years of age. The safe margin of EMPD was 2.0 cm, CMM was 2.0 cm.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R739.5
，
本文編號(hào)：2223493
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