光动力荧光诊断与皮肤原位鳞状细胞癌5一氨基酮戊酸光动力治疗疗效的相关性研究

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中图分类号R541 【文献标志码】A

【Abstract】Objective：Toinvestigate theasociationbetweenphotodynamicdiagnosis（PDD）andtreatmenteficacyof5-amolevulinicacid（ALA）photodynamic therapy（PDT） inpatients withcutaneous squamouscellcarcinomainsitu（cSCCis）.Methods：Apro spective cohort studywas conducted among the patients with cSCCis who underwent ALA-PDT in Departmentof Dermatology， Huashan Hospital，Fudan University，fromJanuaryO2OtoNovember224.AllpatintswerediagnosedwithSCCisbasedobiopsy， andinvasivesquamouscellcarcinoma wasexcluded.ClinicalinformationwascollctedandPDDwasperforedbefore treatmet，nd thepatientsweredividedintomoderatefluorescencegroupandstrongfluorescencegroupsbasedonfuorescenceintensityAllpatients receivedsixsessonsofPDtreatmentatanintervalof1-2weeks.Teprimaryendpointwastheinitialcompleteclearancerateat3 monthsafterthelasttreatmentsesion，andsecondaryendpoitsrethesustainedcompleteclearanceateat12mothsaftetelast treatmentsesonndtrmntfureate.uliaategressionalis，tesivalesndCoxgioalis wereusedtoivesigtetesociatintenDfluorsceitesityndtreamentefacysellseriuencgfacto fortreatmenteficacyResults：Comparedwiththestongfluorescencegroup，temoderatefluorescencegrouphadsignfcantlylower initialcompleteclearancerate[57.14%（8/14）vs.93.33 % （28/30）， odds ratio OR=O.1Oo，P=O.01o]and sustained complete clearance rate[42.86% （6/14）vs.76.67%（23/30），0R=0.230， P =0.030） ]. The multivariate regression analysis showed that moderate fluorescencewas an independent risk factor for initial complete clearance （ OR=0.030，P=0.030⟩ .The moderate fluorescence group hada 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 fluorescence wasanindependent risk factor for PDT treatment failure（hazard ratio= =3.040，P =0.048）.Therewereno significantdifferences in adverse reactions between the two groups.Conclusion ∵ PDD fluorescence intensity can predict the efficacy of ALA-PDT in patientswithcSCCis.Moderatefluorescenceindicatesahigherriskof reatmentfilure，whichcanhelptoguidecliniciansindeveloping individualized treatment strategies.

【Key wordslphotodynamic diagnosis; photodynamic therapy; cutaneous squamous cel carcinoma in situ ; 5- aminolevulinic acid;fluorescence intensity;treatment efficacy

皮肤原位鳞状细胞癌（cutaneoussquamouscellcarcinomainsitu，cSCCis），又称鲍温病（Bowen'sdis-ease，BD），是一种常见的皮肤肿瘤，其中约 3%～5% 会进展为侵袭性皮肤鳞状细胞癌（cutaneoussqua-mous cell carcinoma，cSCC）]。（剩余10058字）