In Plastic and reconstructive surgery ; h5-index 62.0
BACKGROUND : Marjolin's ulcers are malignant tumors arising from previously injured skin, including burn wounds, scars, chronic ulcers, etc. They have a potentially long latent period. We aimed to establish the prognostic factors for recurrence, metastasis, and disease-specific death related to Marjolin's ulcers.
METHODS : We performed a comprehensive search of PubMed, EMBASE, and the Cochrane Library. After assessing the methodological quality of case series, we performed a meta-analysis and systematic review. Furthermore, we employed machine learning to predict the patients' survival time.
RESULTS : Marjolin's ulcer on the upper limbs, head, and neck had a higher risk of recurrence. Contrastingly, lower-grade lesions, absence of lymph node metastasis, and a tumor diameter of <10 cm were associated with lower recurrence risk. The risks were unrelated to age and latent period. Additionally, patients without lymph node metastasis had a lower risk of developing distant metastasis. Furthermore, the risk of disease-specific death was lower in patients with a lower tumor grade, absent lymph node metastasis, small tumor diameter (<10 cm), and tumors located in regions other than the head and neck. Correlation analysis showed that the age at initial injury was negatively correlated with the latent period of Marjolin's ulcer.
CONCLUSIONS : We found that tumor grade, tumor site, lymph node status, and tumor size are important predictors of a worse prognosis. To integrate these predictors, we created an equation to predict the survival time for individual patients via machine learning processes. Moreover, we found that Marjolin's ulcer developed more quickly in older individuals with injuries.
Cheng Kai-Yuan, Yu Jiaxin, Liu En-Wei, Hu Kai-Chieh, Lee Jian-Jr
2022-Dec-09
