皮肤鳞状细胞癌的研究进展

近年来,皮肤鳞状细胞癌的发病率仍持续上升,且因其临床表现多样,容易误诊延误病情。鉴于此,该文对皮肤鳞状细胞癌流行病学、病因与发病机制、临床表现及组织病理、治疗及预后的研究进展进行综述,希望对皮肤鳞状细胞癌的早期诊断、治疗选择和预防有所帮助。     

皮肤鳞状细胞癌研究进展

近年来的资料分析表明,皮肤鳞状细胞癌发病率有逐年增高趋势,尤其在老年人中。由于皮肤鳞状细胞癌在临床和组织病理学上的多样性,因而误诊的情况常见。有鉴于此,对近年来有关皮肤鳞状细胞癌在基础和临床方面的研究进展,诸如流行病学、病因和发病机制、临床类型和表现、诊断和鉴别诊断、新的治疗措施及其预防进行了综述,以期对皮肤鳞状细胞癌的早期诊断、治疗选择和预防有所帮助。     

端粒酶逆转录酶在皮肤肿瘤原位表达水平的比较

目的　研究端粒酶在皮肤恶性肿瘤发病机制中的作用。方法　采用人端粒酶逆转录酶 (hTERT)cRNA探针与石蜡标本进行原位杂交的方法检测 3 0例皮肤基底细胞癌、15例皮肤鳞状细胞癌、19例脂溢性角化、14例正常皮肤中hTERTmRNA的表达水平 ,并进行比较。结果　hTERT阳性率基底细胞癌为 73 .3 5 %(2 2 /3 0 ) ,鳞状细胞癌为80 .0 0 %(12 /15 ) ,均明显高于脂溢性角化 3 6.84%(7/19)和正常皮肤 2 8.5 7%(4 /14 ) ,并具有统计学意义。结论　hTERT在恶性皮肤肿瘤中的阳性表达率明显高于良性肿瘤和正常皮肤 ,提示端粒酶在皮肤恶性肿瘤发病机制中起着重要作用。原位杂交检测hTERT表达水平的方法有可能成为鉴别皮肤良恶性肿瘤的辅助检查手段。     

转基因动物技术研究皮肤肿瘤

基底细胞癌和鳞状细胞癌是常见的皮肤肿瘤，其发病与多种因素有关。从遗传学的角度上看肿瘤是一种基因病，以往由于研究条件的限制，人们对于涉及的基因并不了解。随着转基因以及基因打靶技术的不断完善，研究者已经能够精确研究肿瘤发病中相关基因的具体作用，这对于明确肿瘤发病机制及指导治疗均提供有利的平台。以基底细胞癌和鳞状细胞癌为例，对转基因动物技术在皮肤肿瘤研究领域的最新研究进展概述。     

皮肤鳞状细胞癌诊疗专家共识（2021）

【摘要】 皮肤鳞状细胞癌是非黑素瘤皮肤癌中最常见的肿瘤之一。近年来随着对其发病机制研究的深入以及诊断技术、Mohs显微描记手术、靶向治疗、免疫治疗的发展，皮肤鳞状细胞癌的诊疗取得了较大进展。该共识在国内外近期文献及诊疗指南的基础上，结合我国的诊疗现状，重点阐述皮肤鳞状细胞癌的临床表现及分型、病理活检及报告规范、风险等级评估、分级分期以及规范化治疗等，为临床医生的诊疗工作提供参考依据。     

Caspase-3在皮肤鳞状细胞癌及光线性角化病中的表达

目的：检测Caspase-3在皮肤鳞状细胞癌及光线性角化病组织中的表达。方法： 应用免疫组化法检测16例皮肤鳞状细胞癌皮损、27例光线性角化病皮损及24例正常皮肤组织中Caspase-3蛋白的表达。结果：Caspase-3在皮肤鳞状细胞癌、光线性角化病及正常皮肤组织的表达率分别为37.50%,51.85%,79.17%,其表达含量在皮肤鳞状细胞癌、光线性角化病、正常皮肤组织逐渐增加。结论：Caspase-3蛋白表达下调可能参与皮肤鳞状细胞癌及光线性角化病的发病过程。     

Livin和Caspase-3在皮肤基底细胞癌和皮肤鳞状细胞癌组织中的表达及相关性分析

目的了解皮肤基底细胞癌和皮肤鳞状细胞癌组织中Livin和Caspase-3的表达情况及二者的关系。方法采用免疫组化法检测25例基底细胞癌、18例鳞状细胞癌组织中Livin和Caspase-3的表达情况。结果①Livin蛋白在正常皮肤组织中不表达,基底细胞癌和鳞状细胞癌组织中Livin蛋白的阳性表达率分别为64.00%和72.22%。②Caspase-3在正常皮肤组织中表达,且明显高于基底细胞癌和鳞状细胞癌组织中Caspase-3的表达。③Caspase-3的表达与Livin的表达呈显著负相关。结论Livin在基底细胞癌和鳞状细胞癌组织中高表达,Caspase-3蛋白在基底细胞癌和鳞状细胞癌组织中低表达,且与Livn的表达呈负相关,提示二者可能共同参与基底细胞癌和鳞状细胞癌发病过程。     

日光性角化病与鳞状细胞癌

日光性角化病是一种常见的皮肤癌前病变，部分病变可发展成鳞状细胞癌，而鳞状细胞癌是除恶性黑素瘤以外的最具侵袭性生长能力的皮肤恶性肿瘤。因此早期诊断和治疗甚为重要。综述日光性角化病的发病情况、可能发展为鳞状细胞癌的实验研究进展。     

皮肤鳞状细胞癌患者血清微量元素硒和锌含量分析

目的：探讨微量元素硒和锌在皮肤鳞状细胞癌发病中的作用。方法：采用原子荧光谱法对34例皮肤鳞状细胞癌患者,80例健康人进行血清硒和锌的含量检测。结果：皮肤鳞状细胞癌患者血清硒和锌的含量低于健康对照组,差异有统计学意义（P〈0.01）。结论：皮肤鳞状细胞癌引起患者硒和锌缺乏;对皮肤鳞状细胞癌患者适当补硒和锌,可能是一种合理、有效的治疗手段。     

β人乳头瘤病毒与皮肤鳞状细胞癌的相关性研究进展

人乳头瘤病毒根据侵犯部位的不同可分为黏膜型和皮肤型.皮肤型人乳头瘤病毒多为β人乳头瘤病毒,其与皮肤鳞状细胞癌的相关性尚有争议.近年来随着皮肤鳞状细胞癌发病率的增加,其发病机制及β人乳头瘤病毒与皮肤鳞状细胞癌的病因学关系引起了重视.流行病学资料显示,β人乳头瘤病毒与皮肤鳞状细胞癌相关,但是也有部分证据不支持.随着研究的深入,有研究指出,β人乳头瘤病毒可能作为协同致癌因子诱导皮肤鳞状细胞癌的产生,但不参与肿瘤的维持发展过程.     

氨基酮戊酸光动力疗法治疗前后SKH-1小鼠皮肤鳞状细胞癌组织中免疫细胞亚群变化

【摘要】 目的 研究氨基酮戊酸光动力疗法（ALA-PDT）对小鼠皮肤鳞状细胞癌（cSCC）的免疫效应。方法 建立紫外线诱导的SKH-1无毛小鼠cSCC模型,进行ALA-PDT治疗,在治疗前及治疗后1、3、6、12、24 h和3 d、7 d各取5 mm3大小皮肤组织,采用免疫组化及流式细胞仪检测不同时间点小鼠肿瘤组织免疫细胞浸润情况,包括中性粒细胞、巨噬细胞、T细胞、B细胞、自然杀伤细胞和树突细胞。采用SPSS16.0软件进行两样本均数t检验。结果 与治疗前相比,小鼠cSCC肿瘤局部中性粒细胞和巨噬细胞数量及比例在ALA-PDT治疗后1 h增高最明显［免疫组化结果（每400倍视野细胞数量）：61.22 ± 6.65比22.56 ± 4.13,59.67 ± 4.30比21.89 ± 3.26,均P＜0.05;流式细胞仪结果：（35.64 ± 15.33）%比（5.46 ± 2.44）%,（12.15 ± 4.86）%比（1.98 ± 1.49）%,均P＜0.05］。同时,免疫组化和流式细胞仪检测均显示肿瘤局部T细胞、B细胞、自然杀伤细胞及树突细胞在治疗后6 h表达显著增高（均P＜0.05）。达峰后,肿瘤组织中上述细胞数量和比例下降,但仍高于治疗前,并持续至本研究终点（治疗后第7天）。结论 ALA-PDT通过招募免疫细胞发挥抗肿瘤作用,其中以中性粒细胞和巨噬细胞最为明显。     

葡萄糖转运蛋白3在皮肤鳞状细胞癌中的表达及其对A431细胞增殖、侵袭及迁移的影响

目的探究葡萄糖转运蛋白3(GLUT3)在皮肤鳞状细胞癌(cSCC)中的表达及其对cSCC细胞系A431的影响。方法收集2016年6月至2020年12月经北京大学第三医院皮肤科病理确诊为cSCC患者的石蜡组织标本22份, 皮肤科手术中废弃的正常皮肤组织20份作为对照, 采用免疫组化法检测cSCC和正常皮肤组织中GLUT3的表达。将A431细胞分为GLUT3过表达组和阴性对照组, 分别转染携带SLC2A3基因的慢病毒载体和慢病毒空载体。实时荧光定量PCR及Western印迹法检测各组细胞中GLUT3 mRNA及蛋白的表达水平, MTS法检测各组细胞增殖活力, 动态细胞成像分析系统Incucyte S3实时检测各组细胞的迁移和侵袭能力。分别用葡萄糖及乳酸试剂盒检测并比较各组细胞48 h葡萄糖消耗量及乳酸产生量。两组间比较采用两独立样本t检验, 多组间比较采用单因素方差分析。结果 cSCC组织中GLUT3的表达[免疫组化评分:(9.39 ± 2.56)分]显著高于正常皮肤组织[(2.30 ± 2.60)分], t = 8.91, P<0.05。与A431细胞阴性对照组相比, GLUT3过...     

IL-23／Th17细胞／IL-17通路在皮肤科的研究进展

IL-23是-个由IL-23p19和IL-12p40组成的异二聚体细胞因子,属IL-12细胞因子家族成员,其能够增加已分化的Thl7细胞的数量,保持Thl7细胞所产生的IL-17水平并维持Thl7细胞的存活,依赖IL-23的信号途径在Thl7细胞致病活性中起到重要的作用。目前发现,IL-23/Th17细胞,IL-17通路的紊乱与多种皮肤病的发病相关,针对该通路的特异性治疗可能会带来新的治疗前景。     

Molecular genetics of cutaneous squamous cell carcinoma: perspective for treatment strategies

Cutaneous squamous cell carcinoma (cSCC) represents 20% of all skin cancers. Although primary cSCCs can be successfully treated with surgery, a subset of highly aggressive lesions may progress to advanced disease, representing a public healthcare problem with significant cancer-related morbidity and mortality. A complex network of genes (TP53, CDKN2A, NOTCH1 and NOTCH2, EGFR and TERT) and molecular pathways (RAS/RAF/MEK/ERK and PI3K/AKT/mTOR) have been shown to play an important role in the pathogenesis of cSCC. The epigenetic regulation of TP53 and CDKN2A is an attractive therapeutic target for the treatment of cSCC, as well as NOTCH-activating agents capable to restore its tumour-suppressor function. EGFR inhibitors including both monoclonal antibodies (cetuximab and panitumumab) and tyrosine kinase inhibitors (erlotinib, gefitinib and dasatinib) have been used in clinical trials for the treatment of advanced cSCC, achieving only partial clinical benefit. Recently, an immune-modulatory drug (cemiplimab) has been introduced for the treatment of advanced cSCC with good clinical results and a favourable safety profile, while other PD1/PD-L1 inhibitors, either as monotherapy or in combination with targeted therapies, are currently under investigation. This review focuses on molecular findings involved in the pathogenesis of cSCC and their implications for the future development of new treatment strategies. In addition, current and ongoing treatments on targeted therapies and/or immunotherapy are illustrated.     

白介素-23／Th17通路在银屑病的研究进展

近年来,研究者广泛开展银屑病IL-23／Th17通路的遗传学研究,发现该通路多个相关基因,如IL12B、IL23R、TYK2、STAT3和TRAF3IP2等与银屑病的易感性强关联。研究者进一步探讨该通路中基因-基因交互作用对银屑病发病的影响,为银屑病的遗传学发病机制研究提供了新的内容。未来还需对该通路相关基因和基因-基因交互作用进行深入研究,最终将研究成果转化到银屑病的临床应用。     

Cutaneous Squamous Cell Carcinoma: A Review of High-Risk and Metastatic Disease

Non-melanoma skin cancer represents one-third of all malignancies and its incidence is expected to rise until the year 2040. Cutaneous squamous cell carcinoma (cSCC) represents 20 % of all non-melanoma skin cancer and is a deadly threat owing to its ability to metastasize to any organ in the body. Therefore, a better understanding of cSCC is essential to strengthen preventative measures and curable treatment options. Currently, research demonstrates that cSCC is diagnosed at a rate of 15–35 per 100,000 people and is expected to increase 2–4 % per year. With respect to metastatic cSCC, this disease is more common in men; people over the age of 75 years; and inhabitants of the south and mid-west USA. In 2010, the American Joint Committee on Cancer updated the Cancer Staging Manual’s primary tumor designation to now include high-risk factors; however, factors such as immunosuppression and tumor recurrence were not included. Other staging systems such as Brigham and Women’s Hospital have allowed for increased stratification of cSCC. High-risk cSCC is defined as a cSCC that is staged as N0, extends beyond basement membrane, and has high-risk features associated with sub-clinical metastasis. High-risk features are depth of invasion (>2 mm), poor histological differentiation, high-risk anatomic location (face, ear, pre/post auricular, genitalia, hands, and feet), perineural involvement, recurrence, multiple cSCC tumors, and immunosuppression. Epidermal growth factor receptor and nuclear active IκB kinase (IKK) expression are also predictive of metastatic capabilities. Clinically, the initial lesions of a cSCC tumor can present as a painless plaque-like or verrucous tumor that can ultimately progress to being large, necrotic, and infected. Tumors can also present with paresthesias or lymphadenopathy depending on the location involved. With respect to prognosis, metastatic cSCC is lethal, with several large studies demonstrating a mortality rate of >70 %. Therefore, treatment of metastatic cSCC is difficult and depends on the location involved and extent of metastasis. Treatment options include surgery, radiation therapy, chemotherapy, and any combination of the above. Surgery alone can be used for metastatic cSCC treatment, but is not as effective as surgery in conjunction with radiation therapy. Radiation therapy has some success as a monotherapy in low-risk or cosmetically sensitive areas such as the external ear, eyelid or nose. According to the 2013 National Comprehensive Cancer Network Guidelines, cisplatin as a single agent or combined with 5-fluorouracil hold the strongest support for the treatment of metastatic cSCC; however, the supporting evidence is inconsistent and a curative chemotherapeutic approach is still lacking. Epidermal growth factor receptor inhibitors are a newer class of agents being used in metastatic cSCC and hold some promise as a therapy for this disease. Other areas of interest in finding curative treatments for metastatic cSCC include p53, hypermethylation of specific genes, chromatin remodeling genes, and the RAS/RTK/PI3K pathway. This review addresses the epidemiology, staging, risk factors, clinical presentation, management, and new trends in the treatment of high-risk and metastatic cSCC.     

小檗碱对皮肤鳞状细胞癌裸鼠模型的抑制作用及其机制研究

【摘要】 目的 研究小檗碱对皮肤鳞状细胞癌（cSCC）-A431裸鼠移植瘤的体积、重量、细胞增殖及凋亡的影响，探索小檗碱抑制cSCC的可能机制。方法 培养A431细胞，于20只裸鼠背部皮下注射A431细胞悬液建立cSCC移植瘤裸鼠模型。接种第15天，将荷瘤裸鼠随机平均分为4组：低、中、高剂量组裸鼠腹腔分别注射10、20、25 mg/kg小檗碱溶液，对照组腹腔注射生理氯化钠溶液，每日1次，连续给药35 d。分别于给药前、给药第7、14、21、28、35天检测移植瘤体积。实验结束后，处死裸鼠并随即剥离瘤块称重，计算肿瘤生长抑制率。移植瘤行组织病理检查，免疫组化检测Ki67表达水平，TUNNEL染色检测移植瘤组织中凋亡细胞数，荧光定量PCR和Western印迹法分别检测凋亡相关蛋白Bax、Bcl-2、caspase-3和Ezrin mRNA和蛋白的表达。多组间比较采用单因素方差分析，各组与对照组比较采用Dunnett-t检验。结果 随小檗碱剂量升高和作用时间延长，肿瘤生长曲线逐渐变平缓，各小檗碱组肿瘤生长受到不同程度的抑制，其中高剂量组肿瘤生长抑制作用最明显。小檗碱低、中、高剂量组肿瘤生长抑制率分别为31.05%、66.68%、76.49%，瘤重均显著低于对照组（t = 4.07、6.33、7.26，均P < 0.01）。移植瘤组织病理检查显示，随小檗碱剂量的增加，肿瘤细胞坏死程度和范围增加。免疫组化显示，随小檗碱剂量的增加，Ki67阳性细胞逐渐减少。此外，低、中、高剂量组Ki67阳性细胞数均显著低于对照组（均P < 0.01），而凋亡细胞数均显著高于对照组（P < 0.05或 < 0.01）。4组Bax、Bcl-2、caspase-3、Ezrin mRNA及蛋白表达差异均有统计学意义（均P < 0.01）。其中，小檗碱低、中、高剂量组Bcl-2 mRNA的表达均显著低于对照组（均P < 0.01），中、高剂量组Bcl-2蛋白表达显著低于对照组（均P < 0.01）；高剂量组Bax mRNA及中、高剂量组caspase-3 mRNA的表达均显著高于对照组（P < 0.05或 < 0.01），而低、中、高剂量组Bax、caspase-3蛋白表达量均显著高于对照组（均P < 0.01）；仅高剂量组Ezrin mRNA表达显著高于对照组（均P < 0.01），而低、中、高剂量组Ezrin蛋白表达均显著低于对照组（均P < 0.01）。结论 小檗碱可抑制cSCC-A431裸鼠移植瘤细胞的增殖并促进凋亡，从而一定程度抑制cSCC-A431裸鼠移植瘤的生长，其机制可能与小檗碱上调Bax、caspase-3的表达，同时下调Bcl-2、Ezrin的表达有关。     

银屑病基因-基因交互作用研究进展

全基因组关联研究发现,对基因-基因交互作用在银屑病发病中的研究取得了积极进展,增进了对银屑病遗传学发病机制的认识。目前,银屑病基因-基因交互作用主要集中在主要组织相容性复合体易感区域和IL23／Thl7信号通路。主要组织相容性复合体区域是最早被发现而且是银屑病发病机制中最重要的易感区域。研究表明,其与内质网氨基肽酶1（ERAPl）基因、抑半胱氨酸蛋白酶蛋白A（CSTA）基因、LCE基因簇及染色体19p13区域（PSORS6）等存在相互作用。白介素23／Thl7是一个与慢性炎症性疾病发病密切相关的重要通路,研究发现其中的多个基因在银屑病发病中存在交互作用。     

Update on the anti‐programmed cell death‐1 receptor antibodies in advanced cutaneous squamous‐cell carcinoma

Regarding the rising incidence and the not negligible mortality, the treatment of cutaneous squamous‐cell carcinoma (cSCC) has a high clinical relevance. Immune checkpoint inhibitors (ICI), especially anti‐programmed cell death‐1 receptor (anti‐PD‐1) antibodies such as pembrolizumab and cemiplimab have shown promising results in Phase 2 studies for patients with locally advanced and/or metastatic cSCC. We are presenting a review of the latest results in the treatment of cSCC with ICI. Patients with locally advanced or metastatic cSCC have been treated with cemiplimab 3 mg/kg every 2 weeks. For locally advanced cSCC, an objective response was observed in 44% of patients, 13% patients with a complete response, and 31% with a partial response. For metastatic patients, the overall response rate was 49.2%. The approved dose for cemiplimab in the United States and Europe is 350 mg every 3 weeks. These ICI seem to achieve higher response rates compared with epidermal growth factor receptor (EGFR) inhibitors, with a durable response superior to both chemotherapy and EGFR inhibitors. The side effect profile of anti‐PD‐1 antibodies appears to be favorable compared to chemotherapy. In this way, PD‐1 inhibitors are expected to become the new gold‐standard treatment for patients with locally advanced and metastatic cSCC.