隆突性皮肤纤维肉瘤的预后相关因素分析

Prognosis factors analysis of dermatofibrosarcoma protuberans

目的探讨隆突性皮肤纤维肉瘤（DFSP）的临床特点、治疗方法及局部复发相关因素。方法回顾性分析95例经病理证实不同部位DFSP患者的诊治情况,分析复发病史、肿瘤部位、皮肤切缘距离、皮肤切缘情况、放疗对复发率的影响。结果术后随访时间4-11年,出现局部复发9例（9.47%）,均未出现远处转移,有复发病史、肿瘤位于头颈部、皮肤切缘距离不足3 cm、皮肤切缘阳性更容易出现复发,差异有统计学意义（χ^2分别=3.96、4.18、5.67、5.74,P均〈0.05）。术后放疗能降低局部复发率,但差异无统计学意义（χ^2=0.79,P〉0.05）。结论 DFSP初诊行规范的扩大切除术是降低局部复发率的关键,推荐皮肤切缘距离3 cm及以上,尽可能达到皮肤切缘阴性。对无法皮肤切缘阴性或有多次复发病史患者可将放疗作为补充手段。

Objective To investigate the clinical features, therapies and related factors of local recurrence of dermatofibrosarcoma protuberans（DFSP）. Methods A total of 95 cases of DFSP that confirmed by pathologically were retrospectively reviewed. Recurrent history, tumor location, skin resection margin, skin margin status and the impact of radiation on the recurrence rate were analyzed. Results All patients were followed-up for 4 to 11 years, 9 cases（9.47%） occurred local recurrence but had not occurred distant metastases. The patients who had recurrent history, tumor located on the head and neck, skin resection margin less than 3 cm or positive skin margins were significantly more prone to relapse（χ^2=3.96,4.18,5.67,5.74,P〈0.05）. Postoperative radiotherapy reduced the local recurrence rate, but it was not statistically different（χ^2=0.79,P〉0.05）. Conclusion Adequate initial wide excision is important for patient when DFSP was diagnosed, skin resection margin of 3 cm and more, and as far as possible to negative skin margins. Radiotherapy may play a supplementary role in patients who had repeated recurrent history or with negative skin margins.