Retrospective Analysis Of Clinical Characteristics And Risk Factors Associated With Recurrence Of 71 Patients With Cutaneous Cicatricial Carcinoma

ObjectiveCutaneous cicatricial carcinoma is a aggressive skin malignancy that secondary to the scar or chronic wound and do harmful to human helath,besides,we have insufficient knowledge of its early clinical manifestations so that lead to delaying diagnosis and treatment.The project of this study is to investigate the clinical characteristics and risk factors associated with recurrence of 71 patients of cutaneous cicatricial carcinoma in order to provide a theoretical basis for the prevention and treatment of cutaneous cicatricial carcinoma and reduce the recurrence rate of patients.MethodsWe collected 71 patients with cutaneous cicatricial carcinoma admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2018,then retrospective analyze the gender,age,ultraviolet radiation exposure,cause of scar,latency period,type of scar,lesion size,lesion location,depth of invasion,pathological type,pathological grade,lymph node metastasis,repair method,postoperative adjuvant radiotherapy of the patients that affect the recurrence.The data were entered by software of SPSS22.0,and the chi-square test was used to analyze the factors affecting the recurrence of cutaneous cicatricial carcinoma.Taking p<0.05as the statistical criteria and screen for prognostic factors with statistically significant significance.Results1.General statistics show:(1)Among these 71 cases mentioned above,the ratio of male to female was nearly 1.2:1.0.The age of onset of cutaneous cicatricial carcinoma was 18-85(52±13)years.15.5%of the patients were at a risk of ultraviolet radiation exposure.(2)The major cause of scars was burn,56.4%of the patients were caused by burn injury,the secondary cause was trauma,accounting for 25.6%.The mean latent period was 39±21 years(range from 0.75 to 79 years).The major lesion sites were limbs,47.9%of the patients presented on limbs.The lesion area was 6-205(39±127)cm~2.The most common depth of invasion was full skin and superficial fascia,accounting for 52.1%,deep fascia and muscle accounted for 21.1%,periosteum accounted for 26.8%.The major type of scars were atrophy scars,accounting for69.1%,and hypertrophic scar accounted for 30.9%.(3)The major pathological type was squamous cell carcinoma,accounting for 63.4%and basal cell carcinoma accounted for 36.6%.The major histological grade was well differentiated cutaneous cicatricial carcinoma,which presented in 49 cases(69.1%),medium differentiation accounted for 18.3%and low differentiation accounted for 12.6%.(4)Lymph node metastasis was observed in 10 cases(14.1%).(5)Extended resection was performed on all cases.32 cases(45.1%)accepted skin grafting surgery after tumor resection,28cases(39.4%)with local flap transfer,and 11 cases(15.5%)with pedicle/free flap transfer&skin graft.56 patients(78.9%)accepted postoperative adjuvant radiotherapy,15 patients(21.1%)accepted no postoperative adjuvant radiotherapy.(6)The same type of tumor that reoccured at the same site was defined as recurrence,and recurrence after tumor resection to tumor recurrence was defined as recurrence time.Locoregional recurrence developed in 17 patients and the recurrence rate was 23.9%.The postoperative recurrence time was 2 months at least and 23 months at most.The average was(11.73±9.02)months.2.The factors that influence the prognosis of cutaneous cicatricial carcinoma were included in the univariate analysis.The cause of scar(P=0.048),depth of invasion(P<0.001),pathological grade(P<0.001),lymph node metastasis(P=0.013)and whether postoperative radiotherapy(P=0.008)were statistically significant relevant factor that affecting the prognosis of patients with cutaneous cicatricial carcinoma.Conclusions1.Univariate analysis revealed that the cause of scar,depth of invasion,pathological grade,lymph node metastasis and whether postoperative radiotherapy are the factors of the recurrence of cutaneous cicatricial carcinoma.2.It is an important measure to treat wounds in time,reduce scar hyperplasia,and strengthen the nursing of chronic ulcer wounds.The treatment of instable scar and the prevention of scarring ulcer from refractory wounds is the key to guard against the scar canceration.3.Careful follow-up of high-risk groups with the patients,deep lesion infiltration,poor differentiation,lymph node metastasis and no postoperative adjuvant radiotherapy are essential to prevent recurrence and improve prognosis of cutaneous cicatricial carcinoma.