摘要
目的:探讨光动力荧光诊断(photodynamic diagnosis,PDD)与皮肤原位鳞状细胞癌(cutaneous squamous cell carcinoma in situ,cSCCis)患者接受5-氨基酮戊酸(5-aminolevulinic acid,ALA)光动力治疗(photodynamic therapy,PDT)疗效之间的关系。方法:前瞻性队列研究纳入2020年1月至2024年11月在复旦大学附属华山医院皮肤科接受ALA-PDT治疗的cSCCis患者。所有患者均经病理活检确诊为cSCCis,并排除侵袭性鳞状细胞癌。治疗前收集患者临床信息并进行PDD检查,根据荧光强度将患者分为中等荧光组和强荧光组。所有患者接受6次PDT治疗,每次间隔1~2周。主要终点为末次治疗后3个月的初始完全清除率;次要终点为末次治疗后12个月的持续完全清除率和治疗失败率。采用多因素回归分析、生存曲线和Cox回归分析探讨PDD荧光强度与疗效间的关联和其他影响疗效的因素。结果:中等荧光组(n=14)的初始完全清除率57.14%(8/14)和持续完全清除率42.86%(6/14)均明显低于强荧光组(n=30)93.33%(28/30),持续完全清除率为76.67%(23/30)(OR=0.100,P=0.010;OR=0.230,P=0.030)。多因素回归分析显示,中等荧光是初始完全清除的独立危险因素(OR=0.030,P=0.030)。中等荧光组(n=14)的治疗失败率57.14%(8/14)明显高于强荧光组(n=30)的23.33%(7/30)(P=0.030)。生存分析和Cox回归分析显示,中等荧光是PDT治疗失败的独立危险因素(HR=3.040,P=0.048)。2组间不良反应差异无统计学意义。结论:PDD荧光强度可预测cSCCis患者ALA-PDT疗效。中等荧光提示更易出现治疗失败,这有助于指导临床医生制定个体化治疗策略。
Objective:To investigate the association between photodynamic diagnosis(PDD)and treatment efficacy of 5-aminolevu-linic acid(ALA)photodynamic therapy(PDT)in patients with cutaneous squamous cell carcinoma in situ(cSCCis).Methods:A pro-spective cohort study was conducted among the patients with cSCCis who underwent ALA-PDT in Department of Dermatology,Huashan Hospital,Fudan University,from January 2020 to November 2024.All patients were diagnosed with cSCCis based on biopsy,and invasive squamous cell carcinoma was excluded.Clinical information was collected and PDD was performed before treatment,and the patients were divided into moderate fluorescence group and strong fluorescence groups based on fluorescence intensity.All patients received six sessions of PDT treatment at an interval of 1-2 weeks.The primary endpoint was the initial complete clearance rate at 3 months after the last treatment session,and secondary endpoints were the sustained complete clearance rate at 12 months after the last treatment session and treatment failure rate.The multivariate regression analysis,the survival curves,and the Cox regression analysis were used to investigate the association between PDD fluorescence intensity and treatment efficacy,as well as other influencing factors for treatment efficacy.Results:Compared with the strong fluorescence group,the moderate fluorescence group had significantly lower initial complete clearance rate[57.14%(8/14)vs.93.33%(28/30),odds ratio OR=0.100,P=0.010]and sustained complete clearance rate[42.86%(6/14)vs.76.67%(23/30),OR=0.230,P=0.030)].The multivariate regression analysis showed that moderate fluores-cence was an independent risk factor for initial complete clearance(OR=0.030,P=0.030).The moderate fluorescence group had a significantly higher treatment failure rate than the strong fluorescence group[57.14%(8/14)vs.23.33%(7/30),P=0.030].The survival analysis and the Cox regression analysis showed that moderate fluo-rescence was an independent risk factor for PDT treatment failure(hazard ratio=3.040,P=0.048).There were no significant differences in adverse reactions between the two groups.Conclusion:PDD fluorescence intensity can predict the efficacy of ALA-PDT in patients with cSCCis.Moderate fluorescence indicates a higher risk of treatment failure,which can help to guide clinicians in develop-ing individualized treatment strategies.
作者
朱沁媛
马文涓
栾菁
吴文育
陈淑君
Zhu Qinyuan;Ma Wenjuan;Luan Jing;Wu Wenyu;Chen Shujun(Department of Dermatology,Huashan Hospital,Fudan University)
出处
《重庆医科大学学报》
2025年第8期1115-1121,共7页
Journal of Chongqing Medical University
关键词
光动力荧光诊断
光动力治疗
皮肤原位鳞状细胞癌
5-氨基酮戊酸
荧光强度
疗效
photodynamic diagnosis
photodynamic therapy
cutaneous squamous cell carcinoma in situ
5-aminolevulinic acid
fluo-rescence intensity
treatment efficacy
作者简介
朱沁媛,Email:qinyuan_zhu@fudan.edu.cn,研究方向:皮肤肿瘤的诊疗。;通信作者:陈淑君,Email:cshujun@fudan.edu.cn。
