Oonk Maaike H M, de Hullu Joanne A, Hollema Harry, Mourits Marian J E, Pras Elisabeth, Wymenga Anke N M, van der Zee Ate G J
Department of Gynecologic Oncology, University Hospital Groningen, Groningen, The Netherlands.
Cancer. 2003 Dec 15;98(12):2624-9. doi: 10.1002/cncr.11837.
Vulvar carcinoma patients traditionally are offered follow-up after their primary treatment because earlier diagnosis of recurrent disease is believed to improve chances for curative treatment. The objective of the current study was to determine the value of a strict routine follow-up protocol for the detection of recurrences in a large series of patients who were treated for carcinoma of the vulva.
Clinicopathologic data for patients with primary squamous cell carcinoma of the vulva who were treated between January 1990 and July 2000 were prospectively stored in a database. After treatment, patients visited the outpatient clinic at the study institution at gradually increasing intervals. When a recurrence was diagnosed, it was indicated whether the recurrence was local, occurred in the skin bridge, occurred in the inguinal region, or was distant, and this information was registered. Moreover, it was noted whether the diagnosis was made at a routinely scheduled or at an interval follow-up meeting and whether symptoms as noted by the patient herself led to the diagnosis.
Data from 238 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage I-IV vulvar carcinoma were analyzed with a mean follow-up of 63 months (median, 58 months; range, 6-149 months). Sixty-five of 238 patients (27%) developed recurrent disease; 49 were local recurrences, 2 recurrences were found in the skin bridge, 6 were found in the inguinal region, and 8 were distant recurrences. Forty-two of these 65 recurrences (65%) were detected at a routinely scheduled follow-up meeting, at which time 21 of the 42 patients with recurrent disease (50%) reported symptoms or signs. Local recurrences diagnosed at a routinely scheduled follow-up meeting were found to have a smaller greater dimension (mean, 2.1 cm and median, 1.6 cm; range, 0.3-8.0 cm) compared with recurrences detected at an interval meeting (mean, 3.1 cm and median, 3.0 cm; range, 0.4-7.0 cm) (P = 0.04).
The data from the current study indicated that routinely scheduled follow-up meetings with patients with carcinoma of the vulva result in the detection of smaller recurrences in a substantial proportion of patients compared with self-reported recurrences, without a measurable effect on morbidity or mortality.
外阴癌患者在接受初始治疗后传统上会接受随访，因为人们认为早期诊断复发性疾病可提高治愈性治疗的机会。本研究的目的是确定严格的常规随访方案对于检测大量接受外阴癌治疗患者复发情况的价值。
前瞻性地将1990年1月至2000年7月期间接受原发性外阴鳞状细胞癌治疗的患者的临床病理数据存储在数据库中。治疗后，患者以逐渐延长的间隔时间到研究机构的门诊就诊。当诊断出复发时，需指明复发是局部性的、发生在皮肤桥、腹股沟区还是远处，并记录此信息。此外，还需记录诊断是在常规安排的随访会议上还是在间隔随访会议上做出的，以及患者自己注意到的症状是否导致了诊断。
分析了238例国际妇产科联盟（FIGO）I-IV期外阴癌患者的数据，平均随访时间为63个月（中位数为58个月；范围为6-149个月）。238例患者中有65例（27%）出现复发性疾病；49例为局部复发，2例复发发生在皮肤桥，6例发生在腹股沟区，8例为远处复发。这65例复发中有42例（65%）是在常规安排的随访会议上检测到的，此时42例复发性疾病患者中有21例（50%）报告了症状或体征。与在间隔会议上检测到的复发相比，在常规安排的随访会议上诊断出的局部复发尺寸较小（平均为2.1 cm，中位数为1.6 cm；范围为0.3-8.0 cm），而间隔会议上检测到的复发平均为3.1 cm，中位数为3.0 cm；范围为0.4-7.0 cm（P = 0.04）。
本研究数据表明，与患者自我报告的复发情况相比，对外阴癌患者进行常规安排的随访会议能在相当比例的患者中检测到更小的复发灶，且对发病率或死亡率无显著影响。
