背景:对眼睑皮脂腺癌(SC)进行Mohs显微手术(MMS)或广泛局部切除术(WLE)的决定存在争议。
目的:为了比较局部复发,转移,以及最初接受MMS与WLE治疗的眼睑SC患者的肿瘤相关死亡率。
方法:多中心队列研究。病历被审查与复发相关的因素,转移,和肿瘤相关死亡率。对所有符合条件的患者进行随访。在控制所有混杂因素后,通过Cox分析确定初始手术方式对预后的影响。
结果:在该队列中的360名患者中,115(31.9%)接受MMS作为主要切除,而245例(68.1%)接受WLE。经过60.0个月的中位随访期,MMS组18例(15.7%)和WLE组97例(39.6%)出现局部复发.转移发生在9例(7.8%)接受MMS的患者和38例(15.5%)接受WLE的患者中。总之,MMS组6例(5.2%)和WLE组21例(8.6%)逝世于转移性SC。多变量Cox回归表明,与WLE组相比,MMS组表现出更有利的局部复发控制(风险比[HR],0.42;95%置信区间[CI],0.24-0.73;P=.002),但转移率相当(HR,1.38;95%CI,0.60-3.18;P=0.453)和可比的肿瘤相关死亡率(HR,1.70;95%CI,0.59-4.93;P=.329)。然而,对于Pagetoid上皮内瘤变患者,这种有益效果变得不显著(HR,1.73;95%CI,0.37-8.21;P=.488)。
结论:本研究的回顾性性质。
结论:对于无眼眶受累的眼睑SC,应建议使用MMS,以控制复发;然而,在转移或肿瘤相关死亡率方面,该手术没有改变长期结局.Pagetoid上皮内瘤变患者可能需要辅助措施。
BACKGROUND: The decision to perform Mohs micrographic surgery (MMS) or wide local excision (WLE) for eyelid sebaceous carcinoma (SC) is controversial.
OBJECTIVE: To compare local recurrence, metastasis, and tumor-related mortality of patients with eyelid SC who were initially treated with MMS versus with WLE.
METHODS: A multicenter cohort study. Medical records were reviewed for factors associated with recurrence, metastasis, and tumor-related mortality. All eligible patients were followed up. The impact of initial surgical modality on the prognoses were determined by Cox analyses after control for all confounders.
RESULTS: Of the 360 patients included in this cohort, 115 (31.9%) underwent MMS as primary resection, whereas 245 (68.1%) underwent WLE. After a median follow-up period of 60.0 months, local recurrence was observed in 18 patients (15.7%) in the MMS group and 97 patients (39.6%) in the WLE group. Metastasis occurred in 9 patients (7.8%) who underwent MMS and 38 (15.5%) who underwent WLE. In all, 6 patients in the MMS group (5.2%) and 21 in the WLE group (8.6%) died of metastatic SC. Multivariable Cox regression indicated that compared with the WLE group, the MMS group exhibited more favorable local recurrence control (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.24-0.73; P = .002) but a comparable metastasis rate (HR, 1.38; 95% CI, 0.60-3.18; P = .453) and comparable tumor-related mortality (HR, 1.70; 95% CI, 0.59-4.93; P = .329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR, 1.73; 95% CI, 0.37-8.21; P = .488).
CONCLUSIONS: Retrospective nature of the study.
CONCLUSIONS: MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control; however, this surgical procedure did not change the long-term outcomes in terms of metastasis or tumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.