外科切除与莫氏显微外科手术治疗颌面部基底细胞癌的比较:随机对照研究

作     者：Smeets N.W.J. Krekels G.A.M. Ostertag J.U. 牛新武 

作者机构：Department of DermatologyUniversity Hospital MaastrichtMaastrichtNet herlandsDr. 

出 版 物：《世界核心医学期刊文摘（皮肤病学分册）》 (Digest of the World Core Medical JOurnals:Dermatology)

年 卷 期：2005年第1卷第3期

页      面：5-6页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：基底细胞癌 外科切除 显微外科 颌面部 复发率 随机研究 其他治疗方法 EMBASE 无显著性差异 失访 

摘      要：Background Rates of recurrence of facial basal-cell carcinoma are c onsisten tly lower after Mohs’micrographic surgery (MMS) than after other treatments, such as surgical excision (SE). However, MMS is more time-consuming and theref ore more expensive than SE. We investigated the types of facial basal-cell car cinomas in which MMS was more effective than SE. Methods 408 primary and 204 rec urrent facial carcinomas (374 and 191 patients, respectively) were analysed sepa rately in this prospective randomised study. Patients were assigned SE or MMS (e ach 204 primary, 102 recurrent), and received treatment at two hospitals in the Netherlands. The primary outcome was recurrence of carcinoma. Analysis was by in tention to treat. Findings Of the basal-cell carcinomas included in the trial, 397 primary (198 MMS, 199 SE) and 201 recurrent (99, 102) tumours were actually treated. Of patients with primary carcinomas, 21 had both MMS and SE on differe nt tumours. Nine with recurrent carcinomas had both treatments on different skin tumours. 66 primary and 13 recurrent carcinomas were lost to follow-up. Of th e primary carcinomas, five (3% ) recurred after SE compared with three (2% ) a fter MMS during 30 months of follow-up. Of the recurrent carcinomas, three (3 % ) recurred after SE and none after MMS during 18 months of follow-up. Four recurrent carcinomas randomly assigned to the SE group were treated with MMS. Al though both differences favoured MMS, they were not significant (primary, differ ence 1% (95% CI- 2· 5% to 3· 7% ), P=0· 724; recurrent, 3· 2% (- 2· 0% to 5· 0% ), P=0· 119). Total operative costs of MMS were higher than those of SE (primary e405· 79 vs e216· 86, recurrent e489· 06 vs e323· 49; both P 0. 001). Interpretation No definitive conclusion on recurrence rates o f primary or recurrent basal-cell carcinomas is yet possible. Although recurre nce rates were lower after MMS than after SE, the differences were not significa nt. With comprehensive and reliable