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目的根据乳腺外Paget’s病肿瘤侵犯深度、淋巴结转移及预后情况探讨淋巴结清扫的适应证。方法33例乳腺外Paget’s病患者根据肿瘤侵犯深度分为4组:1原位癌(组1),2侵犯真皮乳头层(组2),3侵犯真皮网状层(组3),4侵犯皮下组织(组4)。比较4组患者的年龄、性别比、随访期、是否合并内脏器官恶性肿瘤、淋巴结转移及预后,探讨淋巴结清扫的适应证。结果原位癌及肿瘤侵犯真皮乳头层患者,无淋巴结转移及死亡病例,12例肿瘤侵犯真皮网状层及皮下组织患者中,10例出现淋巴结转移并死亡。5年生存率为:原位癌及肿瘤侵犯真皮乳头层者100%,肿瘤侵犯真皮网状层者33.3%,侵犯皮下组织组无一例生存。结论对于乳腺外Paget’s病侵犯真皮网状层及皮下组织患者,在局部扩大切除的同时,需选择性做淋巴结清扫。
Objective To investigate the indications of lymph node dissection according to the depth of invasion, lymph node metastasis and prognosis of Paget’s disease. Methods Thirty-three cases of extramammary Paget’s disease were divided into 4 groups according to the tumor invasion depth: 1 in situ carcinoma (group 1), 2 invasive papillary dermis (group 2), 3 invasive dermis reticular layer (group 3), 4 invasive subcutaneous Organization (Group 4). The age, sex ratio, follow-up period, whether or not to combine malignant tumor of internal organs, lymph node metastasis and prognosis were compared between the 4 groups of patients to explore the indications of lymph node dissection. Results In situ carcinoma and tumor invaded dermal papilla patients, no lymph node metastasis and death cases, 12 cases of tumor invasion of dermis reticular layer and subcutaneous tissue, 10 cases of lymph node metastasis and death. The 5-year survival rates were 100% in situ carcinoma and tumor invaded dermal papilla, 33.3% invaded by dermal reticular layer, and none in subcutaneous tissue. Conclusion For patients with extramammary Paget’s disease invading the dermis reticular layer and subcutaneous tissue, selective lymphadenectomy should be performed while locally expanding the resection.