1261例皮膚惡性腫瘤臨床流行病學和手術切緣分析
發(fā)布時間：2018-09-05 06:39
【摘要】：目的通過統(tǒng)計和分析中國醫(yī)學科學院皮膚病醫(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)病情況和變化趨勢提供線索。通過探討皮膚惡性腫瘤的手術切緣與復發(fā)和轉(zhuǎn)移的關系,推薦安全手術切緣與修復術式。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行回顧性分析,所有統(tǒng)計學分析過程均通過SPSS19.0軟件完成。統(tǒng)計學方法主要包括t檢驗、卡方檢驗、Spearman相關分析、方差分析等。統(tǒng)計學方法P0.05認為有統(tǒng)計學意義。結(jié)果共統(tǒng)計皮膚惡性腫瘤患者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。皮膚惡性腫瘤病例中基底細胞癌和鱗狀細胞癌數(shù)量較多,兩者合占總數(shù)的68.2%。從發(fā)病部位來看,BCC患者最常見于頭面部(90.0%),其中鼻部和顴頰部為主(65.7%)；SCC患者中,最常見于頭面部(52.4%)和會陰部(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)計學意義。在手術治療的患者中,BCC患者腫瘤擴切邊緣為0.3cm者與0.5cm者兩組邊緣陽性率比較差異有統(tǒng)計學意義(P0.05),0.5cm者與1.0cm者兩組邊緣陽性率比較差異無統(tǒng)計學意義(P0.05); SCC患者腫瘤切緣為0.5cm者與1.0cm者兩組切緣陽性率比較差異有統(tǒng)計學意義(P0.05),1.0cm者與1.5cm以上者兩組切緣陽性率比較差異無統(tǒng)計學意義(P0.05)。 EMPD患者腫瘤切緣為1.0cm者與2.0cm者兩組切緣陽性率比較差異有統(tǒng)計學意義(P0.05)。55例BCC與16例SCC患者行Mohs手術,無復發(fā)。EMPD患者有效隨訪98例,平均隨訪(5.3±3.7)年,51例失訪,21例復發(fā),復發(fā)率21.4%。179例CMM患者中對31例進行區(qū)域淋巴結(jié)活檢,總共13例陽性,陽性率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)計學差異(矛=3.8,P0.05)。結(jié)論1、本院統(tǒng)計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,并呈增長趨勢。男女患者平均就診年齡無差異,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,與紫外線關系密切。SCC與紫外線的關系不如BCC密切,除曝光部位外SCC常發(fā)生于會陰部。會陰部SCC男性多于女性,49歲以下會陰部為主,50歲以上絕對曝光部位為主。CMM與紫外線關系不大,多數(shù)發(fā)生于肢端,尤其是足底。3、 Mohs手術為BCC與SCC手術金標準,對于無條件行Mohs手術者,可按BCC 0.5cm, SCC 1.0cm作為手術安全邊緣。EMPD安全邊緣為2.0cm, CMM為2.0cm。4、CMM行區(qū)域淋巴結(jié)活檢,對于判斷分期預后有重要意義,皮損破潰者預后差。
[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.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R739.5
，
本文編號：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.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R739.5
，
本文編號：2223493
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