The Analysis Of Surgical Treatment And Recurrent Factors Of Dermatofibrosarcoma Protuberans

Background and ObjectivesDermatofibrosarcoma protuberans(DSFP) is a kind of slow growing low-grade malignant tumor and stem from skin,it is a disease with low prevalence which is between 0.1% and 1.5% in total malignant tumors,but the incidence rate has risen in recent years. DFSP is found in the dermis and subcutaneous tissue only,the deep tissue is rarely involved,it is a kind of common skin neoplasm. DFSP have the characters of aggressive growth in partial human body, and it seldom to metastasize distally. The main treatment of it is operation,but it is tending to recur after excision, the grade of malignancy and invasiveness would increase with the recurrence rate too,and the possibility of recurrence and distant metastasis becomes higher,the tumor recurrence repeatedly and the operation wound greatly affected patient's quality of life. In the early stages of DFSP, the clinical symptoms is not obvious and it grows slowly, it was usually misdiagnosed as benign lesion, without any cure for a long time. The diagnosis of DFSP is mainly based on pathology and is easily misdiagnosed clinically. Some patients underwent simple lump resection as benign lesion, and they didn't have pathologically inspect after the operation. The major problem encountered in the treatment of DFSP is local recurrence. The objective of this study is to analyze the influence factors of patients with DFSP's treatment and recurrence rate,explore the importance of the first treatment for DFSP. MethodsThe retrospective study was done on the basis of 82 patients with DSFP treated in the Department of Plastic Surgery of The First Affiliated Hospital of Zhengzhou University, including 39 index cases and 43 recurrent cases,they were diagnosed pathologically. We could make a retrospective analysis of those patients by collecting patients' previous recurrence history, depth of tumor invasion, positive surgical margins, pathological pattern, the recurrence rate and time. 1.The 82 cases were divided into the index case set(39cases)and the recurrent case set(43cases)according to their operation time of treatment. Analyze the positive surgical margin rate,the recurrence rate and the distant metastasis rate in different sets. 2.The initial operation cases were analyzed in 43 patients with recurrent cases. And 30 patients have unabridged data of the initial operation that satisfied the criteria for this study,divided the 30 cases into the index case set and the recurrent case set and analyze the pathological type after operation,and the depth of invasion in different cases. 3.There are 39 initial patients,23 patients have a second attack and 11 patients have a third attack,9 patients have more than three times attack. Divided the 82 patients into the first case set,the second case set and others,analyze the recurrence rate in different cases. Analyze the clinical factors that have effect on cancer recurrence rate by SPSS 17.0, the recurrence factors of DFSP and the treatment with results were retrospectively analyzed. We use chi-square test and Fisher exact probability to make a statistical analysis of data sets, if P<0.05,there were statistical differences exist. ResultsAll the patients have received surgical resection,The excision extension of operation that recommended by NCCN(National Comprehensive Cancer Network)is 2 to 4cm. The satisfied excision extension for DFSP is 3cm or more from the tumor margin,and the distance can be longer in recurrent tumor. All patients have follow-up observe for more than 5 years, the mean follow-up time was 8 years(5 to 10 years). Two patients' disease have distant lung metastases and no deaths. 1. The positive surgical margins of the first case group is 2.6%(1),the recrudesce case group is 23.3%(10),P<0.05,there were statistical differences exist. The recurrence rate of the first case rate is 7.7%(3),the recrudesce case group is 32.6%(14),P<0.05,there were statistical differences exist. The distant metastatic rate of first case is 0%(0),the recrudesce case group is 4.7%(2),P>0.05,there weren't statistical differences exist. 2. There are 30 patients that met criteria among 43 cases,and 1 people(3.3%)was diagnosed with FS-DFSP after initial treatment,7 people(23.3%)were diagnosed with FS-DFSP after this time,P<0.05,there were statistical differences exit in diagnostic types of tumors. There are 4 patients(13.3%)that the tumor infiltration depth into their deep fascia in initial treatment,22 people(73.3%)were found in this time,P<0.05,there were statistical differences exit in depth of tumor invasion. 3. There are 3 people(7.7%)relapse in the first case set,5 people(21.7%)relapse in the second case set,and 9 people(45%)relapse in other set among the three sets divided by the recurrent number,P<0.05,there are statistical differences exit in the recurrence rate. Conclusions1.Operation is the major therapy of DSFP, we should widely extended resection to reduce the recurrence of tumor.2.The likelihood of tumor recurrence increased with the number of tumor recurrence,the degree of malignancy and the invasiveness of tumor,so we should pay special attention to the initial operation of DFSP.