Background

Atypical fibroxanthoma (AFX) is a fibrohistiocytic tumor with relatively high local recurrence rates but low metastatic potential. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are common treatments, although no consensus exists regarding optimal therapy.

Objective

To systematically review evidence of AFX recurrence and metastatic rates after different surgical modalities.

Methods

A comprehensive search was performed for articles published from 1946 or database inception to March 20, 2017. Studies selected included those that had 5 or more patients with atypical fibroxanthoma treated surgically. Two reviewers independently abstracted the data. Risk of bias was assessed with the Newcastle-Ottawa scale. Main outcomes and measures included recurrence and metastasis.

Results

In total, 23 studies were selected (907 patients and 914 tumors); 175 patients were treated with MMS (recurrence rate 2.0%, 95% confidence interval [CI] 0%-4.1%; metastatic rate 1.9%, 95% CI 0.1%-3.8%), and 732 were treated with WLE (recurrence rate 8.7%, 95% CI 5%-12.3%; metastasis rate 1%, 95% CI 0.2%-1.9%). Among immunocompromised patients, no recurrence or metastases developed in the MMS subgroup, although 4 of 10 recurred and 1 of 10 metastasized in the WLE subgroup.

Limitations

Low quality of the studies published.

Conclusion

MMS for atypical fibroxanthoma is associated with a lower recurrence rate than WLE.

中文翻译：

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非典型纤维性黄瘤：莫氏显微外科手术或切除术的系统评价和荟萃分析

背景

非典型纤维性黄瘤（AFX）是一种纤维组织细胞性肿瘤，具有较高的局部复发率，但转移潜能较低。广泛的局部切除术（WLE）和莫氏显微外科手术（MMS）是常见的治疗方法，尽管关于最佳治疗尚无共识。

客观的

要系统地审查不同手术方式后AFX复发和转移率的证据。

方法

对1946年以来发表的文章或数据库成立至2017年3月20日的文章进行了全面搜索。选择的研究包括接受手术治疗的5例或以上非典型纤维性黄瘤患者。两位审稿人独立提取了数据。用纽卡斯尔-渥太华量表评估偏倚的风险。主要结果和措施包括复发和转移。

结果

总共选择了23项研究（907例患者和914例肿瘤）。175例接受MMS治疗（复发率2.0％，95％置信区间[CI] 0％-4.1％;转移率1.9％，95％CI 0.1％-3.8％），732例接受WLE治疗（复发率8.7 ％，95％CI 5％-12.3％；转移率1％，95％CI 0.2％-1.9％）。在免疫功能低下的患者中，尽管在WLE亚组中10例中有4例复发且10例中有1例复发，但MMS亚组中没有复发或转移。

局限性

研究发表质量低下。

结论

与非WLE相比，非典型纤维性黄瘤的MMS复发率较低。