J Am Acad Dermatol:老年人基底细胞癌手术治疗负担、预后和总生存率的预测因素

2022-09-12 医路坦克 MedSci原创

基底细胞癌(BCC)是最常见的皮肤癌类型,通常表现为生长缓慢、恶性程度低,最初通常无症状,本文的目的是评估和确定患者治疗负担、治疗结果和总生存率。

基底细胞癌(BCC)是最常见的皮肤癌类型,通常表现为生长缓慢、恶性程度低,最初通常无症状。基底细胞癌由于局部组织侵袭和功能恶化,尤其是在头颈部,可导致严重的长期发病率。由于基底细胞癌的发病率不断上升,而且基底细胞癌最常见于老年人,因此,基底细胞癌老年人构成了一个庞大且快速增长的群体。老年人的最佳BCC管理可能很复杂,需要平衡治疗不足和过度的风险。当剩余寿命预计短于出现BCC相关症状(例如,毁容、出血、感染)的时间时,放弃治疗(以及不适、并发症的相关风险)可能是合理的。然而,在异质性老年人群中,预期治疗负担和有限预期寿命(LLE)可能难以确定。因此,当患者由于错误判断LLE或预期治疗负担而未得到最佳治疗时,可能会出现治疗不足。在医疗决策中纳入与虚弱相关的患者特征(如多发病率和/或功能状态)可能会有所帮助,因为在多个医疗领域,虚弱与死亡率和并发症率增加相关。

本文的目的是评估和确定患者治疗负担、治疗结果和总生存率的预测因素≥70岁,头颈部BCC行手术治疗。

方法:从前瞻性多中心BATOA(“老年人基底细胞癌治疗”)队列研究中提取数据,以评估经验治疗负担(视觉模拟量表0-10cm;分数较低表示治疗负担较高)、治疗结果和死亡率

结果:纳入539例患者(中位年龄:78岁)。患者总体治疗负担较低(中位数8.6),美容效果良好。更高治疗负担的预测因素是工具性日常生活活动(iADL)依赖性、女性、并发症、肿瘤直径和多药性。35名(6.5%)患者在随访期间死亡(无BCC相关),死亡率的预测因素是共病指数和iADL依赖性增加。在校正协变量后,Mohs显微手术和常规切除术在这些结果上没有差异。年龄与任何结果均无显著相关性。

Kaplan-Meier曲线显示老年手术治疗患者的生存率估计≥70年)手术治疗头颈部基底细胞癌。

老年患者的总体短期生存率为95%CI≥70年)头颈部基底细胞癌手术治疗,由查尔森共病指数绘制≥3(a)和日常生活依赖性的工具性活动(b)。

结论:BCC管理决策应避免仅基于年龄,而应更多关注患者相关因素。基于这些数据,早期BCC干预对于健康的患者或有症状的患者是有益的。

文献来源:Van Winden MEC,  Bronkhorst EM,  Visch MB,Predictors of surgical treatment burden, outcomes, and overall survival in older adults with basal cell carcinoma: Results from the prospective, multicenter BATOA cohort.J Am Acad Dermatol 2022 05;86(5) 

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    2023-02-21 lishizhe
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