Maggino T, Landoni F, Sartori E, Zola P, Gadducci A, Alessi C, Soldà M, Coscio S, Spinetti G, Maneo A, Ferrero A, Konishi De Toffoli G
Institute of Obstetrics and Gynecology, University of Padova, Padova, Italy.
Cancer. 2000 Jul 1;89(1):116-22. doi: 10.1002/1097-0142(20000701)89:1<116::aid-cncr16>3.0.co;2-4.
Invasive vulvar carcinoma is a rare disease with an incidence rate of 3-5% of all female genital neoplasms. The current study discusses the limited number of articles in the literature regarding the patterns of recurrence as well as the clinical outcome of patients with recurrent disease based on a consistent and consecutive series of cases.
A common clinical chart focusing on the study of patterns of recurrence was used in five Italian gynecologic institutions with uniform criteria of surgical nomenclature, pathologic variables, and sites of recurrence. Between 1980-1994, 502 cases of primary invasive squamous carcinoma of the vulva were registered consecutively, treated, and considered for this multicentered study.
Of 502 patients, 187 (37.3%) developed a recurrence. Distribution of the recurrences by site was as follows: perineal, 53.4%; inguinal, 18.7%; pelvic, 5.7%; distant, 7.9%; and multiple, 14.2%. In a multivariate analysis, 3 characteristics appeared to be statistically correlated with the risk of recurrence: International Federation of Gynecology and Obstetrics Stage > II (P = 0.029), positive lymph nodes (P = 0.009), and vascular space invasion (P = 0.004). The 5-year survival rate was 60% for perineal recurrences, 27% for inguinal and pelvic recurrences, 15% for distant recurrences, and 14% for multiple recurrences.
In the current study the prognostic factors found to have statistical significance as prognostic factors for risk of recurrence were tumor dimension, lymph node involvement, and stromal and vascular space invasion. The presence of inguinal lymph node metastases was predictive of multiple and distant recurrences with a low rate of incidence of isolated perineal recurrence (27%) compared with negative lymph node cases (57.5%). Survival analysis of recurrent disease showed that the surgical resection of local recurrences may provide acceptable results (51% at 5 years). This observation may justify a follow-up program aimed at identifying those patients with early local recurrence suitable for radical resection.
浸润性外阴癌是一种罕见疾病，在所有女性生殖器肿瘤中的发病率为3% - 5%。本研究基于一系列连贯且连续的病例，探讨了文献中关于复发模式以及复发疾病患者临床结局的文章数量有限的情况。
在五家意大利妇科机构使用了一个专注于复发模式研究的通用临床图表，这些机构具有统一的手术命名标准、病理变量和复发部位标准。1980年至1994年期间，连续登记、治疗并纳入502例原发性外阴浸润性鳞状细胞癌病例进行这项多中心研究。
502例患者中，187例（37.3%）出现复发。按部位分布的复发情况如下：会阴，53.4%；腹股沟，18.7%；盆腔，5.7%；远处，7.9%；多处，14.2%。在多变量分析中，有3个特征似乎与复发风险存在统计学相关性：国际妇产科联盟（FIGO）分期> II期（P = 0.029）、淋巴结阳性（P = 0.009）和血管间隙浸润（P = 0.004）。会阴复发的5年生存率为60%，腹股沟和盆腔复发为27%，远处复发为15%，多处复发为14%。
在本研究中，发现具有统计学意义的复发风险预后因素为肿瘤大小、淋巴结受累情况以及间质和血管间隙浸润。腹股沟淋巴结转移的存在预示着多处和远处复发，与淋巴结阴性病例（57.5%）相比，孤立性会阴复发的发生率较低（27%）。复发疾病的生存分析表明，局部复发的手术切除可能会提供可接受的结果（5年时为51%）。这一观察结果可能为旨在识别适合根治性切除的早期局部复发患者的随访计划提供依据。
