1261例皮肤恶性肿瘤临床流行病学和手术切缘分析
发布时间：2018-09-05 06:39
【摘要】：目的通过统计和分析中国医学科学院皮肤病医院皮肤外科住院诊治的皮肤恶性肿瘤患者的基本临床及病理资料,为了解皮肤恶性肿瘤的发病情况和变化趋势提供线索。通过探讨皮肤恶性肿瘤的手术切缘与复发和转移的关系,推荐安全手术切缘与修复术式。方法采用1995年2月至2015年12月在我科确诊的1261例皮肤恶性肿瘤患者临床及病理资料进行回顾性分析,所有统计学分析过程均通过SPSS19.0软件完成。统计学方法主要包括t检验、卡方检验、Spearman相关分析、方差分析等。统计学方法P0.05认为有统计学意义。结果共统计皮肤恶性肿瘤患者1261例,其中男性750例(59.5%),女性511例(40.5%),男女比例有显著性差异。其中EMPD患者男性比例最高,其次为SCC。皮肤恶性肿瘤患者平均年龄为(62.5±13.6)岁,高峰年龄均集中在40-80岁(86.4%)。男性患者年龄大于女性。从1995年至2015年,皮肤恶性肿瘤有明显增加的趋势。皮肤恶性肿瘤病例中基底细胞癌和鳞状细胞癌数量较多,两者合占总数的68.2%。从发病部位来看,BCC患者最常见于头面部(90.0%),其中鼻部和颧颊部为主(65.7%)；SCC患者中,最常见于头面部(52.4%)和会阴部(18.0%),头面部中以颧颊部和头皮(71.8%)为主。SCC中,发生在会阴部的性别构成比存在差异,0-49岁和50岁以上患者发病部位构成比差异有统计学意义。在手术治疗的患者中,BCC患者肿瘤扩切边缘为0.3cm者与0.5cm者两组边缘阳性率比较差异有统计学意义(P0.05),0.5cm者与1.0cm者两组边缘阳性率比较差异无统计学意义(P0.05); SCC患者肿瘤切缘为0.5cm者与1.0cm者两组切缘阳性率比较差异有统计学意义(P0.05),1.0cm者与1.5cm以上者两组切缘阳性率比较差异无统计学意义(P0.05)。 EMPD患者肿瘤切缘为1.0cm者与2.0cm者两组切缘阳性率比较差异有统计学意义(P0.05)。55例BCC与16例SCC患者行Mohs手术,无复发。EMPD患者有效随访98例,平均随访(5.3±3.7)年,51例失访,21例复发,复发率21.4%。179例CMM患者中对31例进行区域淋巴结活检,总共13例阳性,阳性率41.9%。103例随访患者中,19例死亡,死亡率18.4%,其中13例死于恶性黑素瘤转移,6例死于其它原因,5年生存率88.4%。采用区域淋巴结活检有25例,其中转移9例,转移者死亡6人,5年生存率44.4%。随访的恶性黑素瘤中,有破溃者66例(64.1%),12例因该病死亡：无破溃者37例(35.9%),1例因该病死亡。破溃组与非破溃组死亡率有明显统计学差异(矛=3.8,P0.05)。结论1、本院统计的皮肤恶性肿瘤男女比例有显著性差异,男性患者比女性多,平均年龄为(62.5±13.6)岁,并呈增长趋势。男女患者平均就诊年龄无差异,男性患者平均就诊年龄为(62.6±13.3)岁,女性患者为(62.4±14.1)岁。2、BCC和SCC病例数量最多,与紫外线关系密切。SCC与紫外线的关系不如BCC密切,除曝光部位外SCC常发生于会阴部。会阴部SCC男性多于女性,49岁以下会阴部为主,50岁以上绝对曝光部位为主。CMM与紫外线关系不大,多数发生于肢端,尤其是足底。3、 Mohs手术为BCC与SCC手术金标准,对于无条件行Mohs手术者,可按BCC 0.5cm, SCC 1.0cm作为手术安全边缘。EMPD安全边缘为2.0cm, CMM为2.0cm。4、CMM行区域淋巴结活检,对于判断分期预后有重要意义,皮损破溃者预后差。
[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.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R739.5
，
本文编号：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.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R739.5
，
本文编号：2223493
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