Woolderink Jorien M, de Bock Geertruida H, de Hullu Joanne A, Davy Margaret J, van der Zee Ate G J, Mourits Marian J E
Department of Gynaecological Oncology CMC V, University Medical Center Groningen, University of Groningen, 4th floor, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Gynecol Oncol. 2006 Oct;103(1):293-9. doi: 10.1016/j.ygyno.2006.03.010. Epub 2006 May 2.
To analyze patterns and frequency of recurrences of squamous cell carcinoma (SCC) of the vulva after wide local excision (WLE) and superficial inguinal lymphadenectomy with separate incisions and to identify prognostic factors for the development of recurrences.
Between January 1985 and December 1999, all 125 consecutive patients with primary SCC of the vulva, treated with WLE and superficial inguinal lymphadenectomy, were retrospectively analyzed. Recurrences were registered by localization as: local, skin bridge, groin or distant.
A local recurrence was diagnosed in 29 (23%) patients, 11 (9%) developed a groin and 4 (3%) a distant recurrence. No skin bridge recurrences were identified. The 5 years local relapse-free survival was 70%. After a first local recurrence, 72% of these patients developed a second local recurrence. Adjusted for other predictors, older age (>74 years) is an independent risk factor for local recurrences (HR: 2.38; 95%-C.I.: 1.08-5.23) and stage III/IV cancer for developing groin/distant recurrences (HR: 3.03; 95%-C.I.: 1.0-9.18).
WLE and superficial inguinal lymphadenectomy with separate incisions result in a high groin recurrence rate in this study; superficial lymphadenectomy should be replaced by deep inguinofemoral lymphadenectomy. After a local recurrence, 72% of the patients developed a second local recurrence. These patients are at high risk and need a close follow-up.
分析采用单独切口的广泛局部切除术（WLE）和浅表腹股沟淋巴结清扫术治疗外阴鳞状细胞癌（SCC）后的复发模式和频率，并确定复发的预后因素。
回顾性分析1985年1月至1999年12月期间连续接受WLE和浅表腹股沟淋巴结清扫术治疗的125例原发性外阴SCC患者。根据复发部位记录为：局部、皮桥、腹股沟或远处。
29例（23%）患者诊断为局部复发，11例（9%）出现腹股沟复发，4例（3%）出现远处复发。未发现皮桥复发。5年局部无复发生存率为70%。首次局部复发后，72%的患者出现第二次局部复发。校正其他预测因素后，年龄较大（>74岁）是局部复发的独立危险因素（HR：2.38；95%置信区间：1.08 - 5.23），III/IV期癌症是发生腹股沟/远处复发的危险因素（HR：3.03；95%置信区间：1.0 - 9.18）。
在本研究中，采用单独切口的WLE和浅表腹股沟淋巴结清扫术导致腹股沟复发率较高；浅表淋巴结清扫术应改为深部腹股沟股淋巴结清扫术。局部复发后，72%的患者出现第二次局部复发。这些患者风险较高，需要密切随访。
