Response to Rogers et al.
Response to Rogers et al.
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对罗杰斯等人的回应
DOI：
10.1038/jid.2013.450
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Chren,Mary-Margaret
中科院分区：
文献类型：
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作者：
Chren,Mary-Margaret
罗杰斯博士和他的同事断言我们的结论是错误的或受到研究设计的影响，这是没有根据的。我们仔细研究了两年多来在我们学术医疗中心的两家繁忙医院诊断出的每一位基底细胞癌或皮肤鳞状细胞癌患者。我们对几乎所有的病人都进行了很好的随访，我们在汇总他们之前分别分析了两家医院的病人。我们没有发现任何证据表明Mohs手术后的长期复发率低于切除后的长期复发率，即使进行了多种分析，调整了患者、肿瘤和护理特征的差异。我们的结论是，复发率的任何差异只能在随机对照试验中确定，在随机对照试验中，具有相似肿瘤的相似患者随机接受一种或另一种治疗。很明显，对于大多数非黑色素瘤皮肤癌，我们的大型前瞻性队列研究和欧洲面部基底细胞癌随机对照试验（Mosterd et al., 2008）没有足够的证据来指导治疗之间的选择。对于我们的专业来说，这意味着我们没有数据证明过去几十年来美国莫氏手术使用率的急剧增长，因为莫氏手术并不是更便宜的治疗方法。（Wilson et al., 2012）由于成本高昂，随机对照试验通常是在观察性研究在重要的、有针对性的情况下证明临床平衡后进行的。这正是我们发现自己患有许多非黑色素瘤皮肤癌的情况。我们的研究结果强烈支持对非黑色素瘤皮肤癌进行手术治疗的重点随机对照试验，我敦促罗杰斯博士及其同事，作为尊敬的莫氏外科医生和领导者，与我一起支持研究这些治疗方法的比较疗效的下一个科学方法。
There is no basis for the assertion by Dr. Rogers and his colleagues that our conclusions were erroneous or affected by the study design. We meticulously studied every patient with basal cell carcinoma or cutaneous squamous cell carcinoma diagnosed over a two-year period at two busy hospitals at our academic medical center. We had excellent follow-up on virtually all patients, and we analyzed patients at the two hospitals separately before pooling them. We could find no evidence that long-term recurrence was lower after Mohs surgery than after excision, even with multiple analyses that adjusted for differences in patient, tumor, and care characteristics. We conclude that any difference in recurrence rates could be determined only in a randomized controlled trial in which similar patients with similar tumors are randomized to receive one treatment or another.It is clear that for most nonmelanoma skin cancers, there is insufficient evidence--from our large prospective cohort study and the European randomized controlled trial in facial basal cell carcinomas (Mosterd et al., 2008)--to guide choices between therapies. What this means for our specialty is that we have no data to justify the dramatic increase in Mohs surgery utilization in the US over the last decades given that Mohs surgery is not the less expensive treatment.(Wilson et al., 2012) Because they are costly, randomized controlled trials often are conducted after observational studies demonstrate clinical equipoise in important, targeted situations. This is precisely the situation in which we find ourselves for many nonmelanoma skin cancers. The results of our studies strongly support a focused randomized controlled trial of surgical treatments for nonmelanoma skin cancer, and I urge Dr. Rogers and colleagues, as respected Mohs surgeons and leaders, to join me in supporting this next scientific approach to studying the comparative efficacy of these treatments.