Clinical stage IA (limited patch and plaque) mycosis fungoides. A long-term outcome analysis.
Clinical stage IA (limited patch and plaque) mycosis fungoides. A long-term outcome analysis.
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DOI：
10.1001/archderm.1996.03890350051009
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发表时间：
1996-11
影响因子：
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通讯作者：
Youn H. Kim;Reini Jensen;Garrett L. Watanabe;A. Varghese;R. Hoppe
中科院分区：
文献类型：
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作者：
Youn H. Kim;Reini Jensen;Garrett L. Watanabe;A. Varghese;R. Hoppe
目的研究IA期蕈样肉芽肿患者的长期治疗结果，分析与疾病进展相关的因素以及初始治疗对生存率和无复发率的影响。设计：单中心，32（1/2）年，回顾性队列分析。设置私人转诊医疗中心。患者122例临床IA期（T1，N 0，M0）蕈样肉芽肿患者。主要观察指标：采用Kaplan-Meier技术计算的长期精算生存率和无复发率。结果IA期蕈样肉芽肿患者的长期（30年）生存率与种族、年龄和性别匹配的对照人群的预期生存率相似。该组的中位生存期尚未达到32（1/2）年。11例（9%）进展为更晚期疾病的患者对初始治疗的完全缓解率低于其他患者（36% vs 82%），平均年龄高于其他T1疾病患者（61 vs 48岁，P <0.05）。122例患者中仅3例（2%）死于疾病。在达到完全缓解的IA期患者中，25%在10年时无复发。接受全皮肤电子束治疗的患者（n = 34）比局部盐酸氮芥（氮芥）治疗的患者有更有利的无复发结局（n = 73，P <0.05）。两个治疗组之间的长期生存率无显著差异。结论：在斯坦福大学接受治疗的临床IA期蕈样霉菌病患者的预期寿命没有改变。只有不到10%的人进展到更晚期，很少有人死于疾病。虽然全身皮肤电子束治疗的反应率上级优于局部氮芥，但长期生存结果相似。局部氮芥是一种具有成本效益和方便的治疗患者有限的补丁和斑块蕈样肉芽肿。
OBJECTIVES To study the long-term results of treatment of patients with stage IA mycosis fungoides and analyze the factors related to disease progression and the effect of initial therapy on survival and freedom from relapse. DESIGN A single-center, 32(1/2)-year, retrospective cohort analysis. SETTING Private referral medical center. PATIENTS One hundred twenty-two patients with clinical stage IA (T1, N0, M0) mycosis fungoides. MAIN OUTCOME MEASURES Long-term actuarial survival and freedom-from-relapse results as calculated by the technique of Kaplan-Meier. RESULTS The long-term (30-year) survival of patients with stage IA mycosis fungoides is similar to the expected survival of a race-, age-, and sex-matched control population. The median survival of this group has not been reached at 32(1/2)-years. Eleven patients (9%) who progressed to more advanced disease had a lower complete response rate to initial therapy than did other patients (36% vs 82%) and an older mean age than did other patients with T1 disease (61 vs 48 years, P < .05). Only 3 (2%) of 122 patients died of disease. Among stage IA patients who achieved a complete response, 25% are relapse free at 10 years. Patients who received total skin electron beam therapy (n = 34) had a more favorable freedom-from-relapse outcome than those treated with topical mechlorethamine hydrochloride (nitrogen mustard) (n = 73, P < .05). No significant difference was seen in the long-term survival between the 2 treatment groups. CONCLUSIONS Patients with clinical stage IA mycosis fungoides treated at Stanford University do not have an altered life expectancy. Fewer than 10% progressed to more advanced stages and few died of disease. Although the response rate to total skin electron beam therapy was superior to that of topical mechlorethamine, the longterm survival results were similar. Topical mechlorethamine is a cost-effective and convenient therapy for patients with limited patch and plaque mycosis fungoides.