Clinical characteristics, treatment, and prognosis of squamous cell carcinoma arising from extremity chronic osteomyelitis: a synthesis analysis of one hundred and seventy six reported cases
Clinical characteristics, treatment, and prognosis of squamous cell carcinoma arising from extremity chronic osteomyelitis: a synthesis analysis of one hundred and seventy six reported cases
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四肢慢性骨髓炎所致鳞状细胞癌的临床特征、治疗和预后：176例报告病例的综合分析。
DOI：
10.1007/s00264-020-04737-0
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发表时间：
2020-07-23
影响因子：
2.7
通讯作者：
Yu, Bin
中科院分区：
文献类型：
--
作者：
Jiang, Nan;Li, Su-yi;Yu, Bin
目的四肢慢性骨髓炎（COM）引起的鳞状细胞癌（SCC）由于其低患病率尚未得到很好的了解。本研究旨在综合最近发表的病例，以阐明其临床特点，治疗和预后。方法检索PubMed、Embase和Cochrane图书馆数据库，检索1990年1月1日至2019年9月30日期间诊断为源自四肢COM的SCC病例的英文文献。采用美国国立卫生研究院（NIH）评估工具评估纳入报告的质量，采用建议评估、发展和评价分级（GRADE）方法总结现有证据的质量。用于分析的综合数据包括临床特征、治疗策略、局部复发、转移、全因和scc相关死亡的发生率。此外，我们还探讨了可能影响SCC治疗效果和预后的潜在因素。结果本分析包括60项研究，176例患者（男女比例为6.7）。COM主要发生在创伤后（73%），胫骨是最常见的部位（61%），窦道是最常见的症状（61%）。从COM到SCC的平均病程为27年。病原菌培养阳性率90%，其中多菌培养阳性率73%。截肢率为80.5%。局部复发率、治疗后转移率、全因死亡率和scc相关死亡率分别为16.7%、12%、31.1%和12.6%。诊断时有局部淋巴结病变的患者的局部复发（P= 0.01）、scc相关（P= 0.02）和全因死亡（P= 0.01）的风险明显高于无局部淋巴结病变的患者。中分化至低分化SCC患者的局部复发风险（P= 0.01）和全因死亡风险（P= 0.02）明显高于高分化SCC患者。结论四肢骨性骨肉瘤多发于男性和胫骨。虽然截肢是主要的治疗方法，但局部复发、转移和scc相关死亡的总体发生率超过10%。诊断为SCC时伴有局部淋巴结病变的患者以及中度至低分化SCC类型的患者应密切随访。
Purpose Squamous cell carcinoma (SCC) arising from extremity chronic osteomyelitis (COM) has not been well-understood due to its low prevalence. This study aimed to synthesize the cases recently published to clarify their clinical characteristics, treatment, and prognosis. Methods PubMed, Embase, and Cochrane Library databases were searched for English literature reporting cases diagnosed of SCC originating from extremity COM between January 1, 1990, and September 30, 2019. The National Institutes of Health (NIH) assessment tool was used to evaluate the quality of reports included, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to summarize the quality of available evidence. The data synthesized for analysis were clinical features, treatment strategy, and incidences of local recurrence, metastasis, all-cause, and SCC-related deaths. In addition, potential factors that might have influenced treatment efficacy and prognosis of SCC were also investigated. Results Included for this analysis were 60 studies of 176 patients (a male-to-female ratio of 6.7). COM mostly occurred following trauma (73%), the tibia was the most frequent site (61%), and a sinus tract was the most common symptom (61%). The mean duration from COM to SCC was 27 years. Positive rate of pathogen culture was 90%, with 73% being polymicrobial. Limb amputation was performed in 80.5% of the patients. Incidences of local recurrence, metastasis after treatment, all-cause, and SCC-related mortalities were 16.7%, 12%, 31.1%, and 12.6%, respectively. Patients with local lymphadenopathy at diagnosis had significantly higher risks of local recurrence (P= 0.01), SCC-related (P= 0.02), and all-cause deaths (P= 0.01) than those without. Patients with moderately-to-poorly differentiated SCC types had significantly higher risks of local recurrence (P= 0.01) and all-cause death (P= 0.02) than those with a well-differentiated type. Conclusions SCC arising from extremity COM favoured males and the tibia. Although limb amputation was the mainstay of treatment, the overall incidences of local recurrence, metastasis, and SCC-related death exceeded 10%. Patients with local lymphadenopathy at diagnosis of SCC and those with moderately-to-poorly differentiated SCC types should be followed up closely.