Dodge J A, Eltabbakh G H, Mount S L, Walker R P, Morgan A
Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
Gynecol Oncol. 2001 Nov;83(2):363-9. doi: 10.1006/gyno.2001.6401.
The best treatment modality and factors affecting recurrence among women with vaginal intraepithelial neoplasia (VAIN) are yet to be determined. The aims of the current study were to describe the clinical features, results of treatment, and factors affecting recurrence among patients with VAIN.
We conducted a retrospective review of 121 women with VAIN after confirming the histologic diagnosis. Patient demographics, clinical features, and results of therapy were recorded. Factors affecting recurrence were assessed using the odds ratio and the 95% confidence intervals among patients who were followed up for 7 months or more and had at least one posttreatment Papanicolaou smear. Significant univariate odds ratios were assessed jointly in a multivariate model with a stratified analysis.
The mean age of the patients was 35.0 (+/-17), 41% of the patients smoked, 39% had a history of human papillomavirus infection, 27% had history of sexually transmitted diseases, 22% had history of surgery for cervical intraepithelial neoplasia (CIN), and 23% had total hysterectomy. The upper third of the vagina was the most common site of VAIN and 61% of the lesions were multifocal. Associated cervical and vulvar intraepithelial neoplasia (VIN) were present in 65 and 10%, respectively. Recurrences of VAIN and progression to invasive vaginal cancer occurred in 33 and 2%, respectively. Recurrences following partial vaginectomy, laser, and 5-fluorouracil were 0, 38, and 59%, respectively (P = 0.0001). Multifocality and method of treatment were significant independent predictors of VAIN recurrences (odds ratio 3.3, 95% CI 1.2, 9.2, P = 0.02, and 22.4, 95% CI 1.3, 393.6, P = 0.001, respectively), with no interaction, based on a stratified analysis.
VAIN occurs most often among women with CIN or VIN, commonly involves the upper third of the vagina, and is often multifocal. Partial vaginectomy provides the highest cure rate and multifocality is a risk factor for recurrence.
阴道上皮内瘤变（VAIN）女性患者的最佳治疗方式以及影响复发的因素尚未确定。本研究的目的是描述VAIN患者的临床特征、治疗结果以及影响复发的因素。
在确认组织学诊断后，我们对121例VAIN女性患者进行了回顾性研究。记录患者的人口统计学信息、临床特征和治疗结果。对于随访7个月或更长时间且至少有一次治疗后巴氏涂片检查的患者，使用比值比和95%置信区间评估影响复发的因素。在多变量模型中通过分层分析联合评估显著的单变量比值比。
患者的平均年龄为35.0（±17）岁，41%的患者吸烟，39%有人乳头瘤病毒感染史，27%有性传播疾病史，22%有宫颈上皮内瘤变（CIN）手术史，23%有全子宫切除术史。阴道上三分之一是VAIN最常见的部位，61%的病变为多灶性。分别有65%和10%的患者合并宫颈和外阴上皮内瘤变（VIN）。VAIN复发和进展为浸润性阴道癌的发生率分别为33%和2%。部分阴道切除术、激光治疗和5-氟尿嘧啶治疗后的复发率分别为0、38%和59%（P = 0.0001）。基于分层分析，多灶性和治疗方法是VAIN复发的显著独立预测因素（比值比分别为3.3，95%置信区间为1.2，9.2，P = 0.02；以及22.4，95%置信区间为1.3，393.6，P = 0.001），且无相互作用。
VAIN最常发生于患有CIN或VIN的女性，通常累及阴道上三分之一，且常为多灶性。部分阴道切除术的治愈率最高，多灶性是复发的危险因素。
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