- 期刊
Recurrence Risk Factors for Head and Neck Dermatofibrosarcoma Protuberans
頭頸部隆突性皮膚纖維肉瘤復發危險因子
摘要
背 景：隆突性皮膚纖維肉瘤（DFSP）由於不對稱的生長形態與高局部侵犯特性，常具有高復發率。常常使用廣泛腫瘤切除來治療此疾病。然而位於頭頸部的隆突性皮膚纖維肉瘤因為解剖位置與美觀考量的特性，使用廣泛腫瘤切除方式常有所困難。目的及目標：在高雄榮總病例系列的研究經驗提供常見疾病復發危險因子與剖析位於頭頸部的隆突性皮膚纖維肉瘤治療方式。材料及方法：我們進行了43例接受廣泛切除的隆突性皮膚纖維肉瘤病例回顧分析。使用邏輯回歸方法來討論多變項分析以確定復發的相關危險因子。並應用這些風險因子於頭頸部隆突性皮膚纖維肉瘤的治療。結 果：所有採用廣泛切除的43例患者之中，有37例是原發腫瘤和6例復發腫瘤。追蹤期間為1至17年不等（追蹤時間中位數在原發腫瘤組為31.2個月，復發組為67.2個月）。共有7例位於頭頸部區域，36例位於其他區域。在43例患者中有6例局部復發，復發率為13.9%。當腫瘤大於6公分，纖維肉瘤變異型的隆突性皮膚纖維肉瘤Fibrosarcoma subtype dermatofibrosarcoma protuberans（FS-DFSP），切除邊界為陽性或接近，多次復發有較高的復發率。在頭頸部區域患者可發現手術切除距離少於其他部位（1.4 vs. 2.85公分）。纖維肉瘤變異型的發生比率也較高，位於頭頸部的隆突性皮膚纖維肉瘤復發率也較高。結 論：較少的手術切除距離和較高比率的纖維肉瘤變異型的隆突性皮膚纖維肉瘤影響了頭頸部隆突性皮膚纖維肉瘤的手術預後。考慮到頭頸部的美觀和解剖位置的特殊性，對於頭頸部隆突性皮膚纖維肉瘤腫瘤是FS-DFSP病理型或第二次復發，我們建議術後考慮放射線輔助治療以達到腫瘤控制。
關鍵字
無資料並列摘要
Background: Dermatofibrosarcoma protuberans (DFSP) has a higher rate of recurrence due to an asymmetric growth pattern and risk of local invasion. Wide local excision (WLE) is usually used; however, wide surgical margins in the head and neck area may be difficult due to anatomical and cosmetic considerations. Aim and Objectives: The case series provides the experiences of a single institution in identifying factors that predict local control and present challenging clinical problems. Materials and Methods: We conducted a retrospective chart review of 43 patients with DFSP that underwent wide excision at our institute. Multiple variables were analyzed to determine the risk factors related to recurrence using a logistic regression method. These risk factors were applied to the treatment of head and neck DFSP. Results: All 43 patients were treated with wide excision. Thirty-seven patients were being treated for a primary tumor, and 6 patients had a recurrence at the initial visit. The follow-up periods ranged from 1 to 17 years, with a median of 31.2 months in the primary tumor group and 67.2 months in the recurrent group. Seven cases were located in the head and neck area, and 36 cases were located in other areas. Six of 43 patients had developed local recurrence. The total recurrence rate was 13.9%. The recurrence rate was higher when the tumor size was ＞6 cm, Fibrosarcoma subtype dermatofibrosarcoma protuberans, positive or close pathological margin, number of recurrences. Narrow surgical margin in head and neck area was statistically significant in our series in comparison to other area DFSP (1.4 vs. 2.85cm, P=0.005). Besides, FS-DFSP was more common in head and neck area (2 of 7 head and neck area patient, 2 of 36 other areas patient, P=0.04). Also, higher recurrence rate in head and neck area DFSP was noted. Conclusion: Complete surgical resection has been accepted as the optimal treatment for local DFSP. Narrow surgical margin and higher FS-DFSP subtype incidence may contribute to higher recurrence rate in head and neck area. Considering the cosmetic and anatomic particularities of the head and neck area, we suggest post-operation adjuvant radiotherapy to achieve local control in patients with fibrosarcomatous transformation, or second recurrences if a narrow surgical margin happen.