| Objective Basal Cell Carcinoma(BCC)is one of the most common skin cancers in the world.It is important to select appropriate treatment methods for different patients to improve their quality of life.Surgical treatment is the main therapeutic means for BCC patients,but scar and recurrence caused by simple surgical resection are easy to cause heavy psychological burden to patients.Therefore,this study aims to explore the clinical application value of the emerging therapeutic method of aminovaleric-photodynamic(ALA-PDT)in the postoperative treatment of BCC patients.The 2021 ALA-PDT Dermatological Clinical Application Guidelines have clearly indicated that it can be used in the treatment of superficial BCCS and nodular BCCS with a depth of < 2mm.However,the clinical application value of ALA-PDT for patients with other types of BCCS not covered in the guidelines is unclear.To sum up,this study will include other types of BBC patients with invasion depth ≥2mm not covered by application guidelines,such as nodule type,infiltration type,pigmentation type,etc.,as research objects to explore the clinical application potential of ALA-PDT in postoperative treatment of such BCC patients.The evaluation indicators of this study are not only conventional clinical efficacy and cosmetic effect,but also It also included the rate of primary wound healing,the rate of adverse reactions,the rate of recurrence,the rate of recurrence in patients with positive incisal margin and the disease-free survival.Methods Patients admitted to Taizhou People’s Hospital from July 1,2019 to July 1,2021 with pathological diagnosis of BCC were included in the study,excluding patients with BCC subtype included in the guidelines for clinical application of ALA-PDT dermatology.A total of 78 patients with BCC were included.All BCC patients were divided into two groups,including the experimental group(treatment group)treated with surgery combined with ALA-PDT and the control group(control group)treated with surgery alone.The number of BCC patients in the treatment group and the control group were 36 and 42,respectively.The patients were followed up for 18 months,and the clinicopathologic data were collected.χ2 test was used to compare the clinical efficacy,cosmetic effect,first-stage wound healing rate,adverse reaction rate and recurrence rate of BCC patients in the two groups.Survival analysis was conducted to compare the disease-free survival of the two groups of BCC patients.Results The BCC patients treated with ALA-PDT were set as the treatment group,and the BCC patients treated with surgery alone were set as the control group.The results showed that the complete response rate of BCC patients in the treatment group was 91.7%(33/36),the partial response rate was 8.3%(3/36),the ineffective response rate was 0%,and the total effective rate was 100%.In the control group,the complete response rate was 76.2%(32/42),the partial response rate was 23.8%(10/42),the ineffective response rate was 0%,and the total effective rate was 100%.There was no significant difference in clinical efficacy between the treatment group and the control group(P > 0.05).The effective rate of the treatment group was 91.7%(33/36),while that of the control group was 73.8%(31/42).The effect of the treatment group was significantly higher than that of the control group,and the difference was statistically significant(P < 0.05).The first-stage wound healing rate in the treatment group was 91.7%(33/36),the second-stage wound healing rate was 8.3%(3/36),the first-stage wound healing rate in the control group was 71.4%(30/42),and the second-stage wound healing rate was 28.6%(12/42).The first-stage wound healing rate in the treatment group was significantly higher than that in the control group.The difference was statistically significant(P < 0.05).In this study,the adverse reactions of patients included dermatitis,scar and hyperpigmentation.There were 7 patients(19.4%,7/36)in the treatment group and 17 patients(40.5%,17/42)in the control group with adverse reactions.The rate of adverse reactions in the treatment group was significantly lower than that in the control group,with statistical significance(P < 0.05).One patient in the treatment group(2.8%,1/36)relapsed,and 7 patients in the control group(16.7%,7/42)relapsed.Compared with the control group,the recurrence rate in the treatment group was significantly reduced,with statistical significance(P < 0.05).Positive tumor cells at the surgical margin were closely related to patients’ recurrence,and the recurrence rate of BCC patients with positive tumor cells at the surgical margin was also significantly lower in the treatment group(0.0%,0/5)than that in the control group(60.0%,3/5)(P < 0.05).The recurrence time of patients in the treatment group was delayed compared with that in the control group.In addition,survival analysis results showed that the disease-free survival time of patients in the control group was longer than that in the control group,and the difference was statistically significant(P < 0.05).Conclusions The combined application of ALA-PDT after surgery could not improve the clinical efficacy of patients with other types of BCC,but could obtain excellent cosmetic effects and improve the first-stage healing rate of surgical incisions.The combined application of ALA-PDT after surgery can also effectively reduce the rate of adverse reactions and recurrence in patients with other types of BCC.The recurrence of patients was associated with positive tumor cells at the surgical margin,and ALA-PDT can significantly reduce the recurrence rate of above BCC patients.ALA-PDT can delay the recurrence time and prolong the disease-free survival of BCC patients in this study. |
