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目的探讨头颈部隆突性皮肤纤维肉瘤(dermatofibrosarcoma protuberans,DFSP)的不同治疗方式对患者预后的影响。方法对1982年至2005年中国医学科学院肿瘤医院头颈外科收治的28例头颈部 DFSP 进行回顾性分析,其中11例行扩大切除(切除边界≥2.0 cm),17例行局部切除(切除边界<2.0 cm);24例行单纯手术切除,4例行术前或术后放疗,放疗剂量为40～65 Gy,同期行缺损修复的共18例。结果总体局部复发率为21.4%(6/28),11例行扩大切除的术后局部复发率为0(0/11),17例行局部切除的术后复发率35.3%(6/17),二者差异有统计学意义(P=0.033);行术前或术后放疗的局部复发率为0(0/4),单纯手术的局部复发率25.0%(6/24),二者差异无统计学意义(P=0.357)。总体5年生存率为88.9%;行扩大切除的5年无复发生存率为100%,行局部切除的5年无复发生存率为59.6%,二者差异有统计学意义(x~2=3.933,P=0.047)。结论扩大切除可以降低头颈部 DFSP 术后的复发率,对于切缘不充分或切缘不净的 DFSP,行局部放疗可能有效。手术缺损较大时应行同期修复。
Objective To investigate the effect of different treatments of dermatofibrosarcoma protuberans (DFSP) on the prognosis of patients with head and neck cancer. Methods 28 cases of head and neck DFSP admitted from 1982 to 2005 in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. Among them, 11 patients underwent extended resection (resection margin≥2.0 cm) and 17 patients underwent partial resection (removal margin < 2.0 cm). Twenty-four patients underwent simple surgical resection and four patients underwent preoperative or postoperative radiotherapy. The dose of radiotherapy was 40-65 Gy, and 18 patients underwent defect repair during the same period. Results The overall local recurrence rate was 21.4% (6/28). In 11 cases, the local recurrence rate was 0 (0/11) after extended excision. The recurrence rate after local excision in 17 cases was 35.3% (6/17) (P = 0.033). The local recurrence rate was 0 (0/4) in preoperative or postoperative radiotherapy and 25.0% (6/24) in simple surgery. The difference between the two groups was statistically significant No statistical significance (P = 0.357). The overall 5-year survival rate was 88.9%. The 5-year recurrence-free survival rate was 100% for extended resection and 59.6% for 5-year partial resection. The difference was statistically significant (x 2 = 3.933 , P = 0.047). Conclusions Enlarged resection can reduce the recurrence rate of head and neck after DFSP. Local DFMA may be effective for DFSP with inadequate margins or unclean margins. Large surgical defects should be performed concurrent repair.