Chan John K, Sugiyama Valerie, Pham Huyen, Gu Mai, Rutgers Joanne, Osann Kathryn, Cheung Michael K, Berman Michael L, Disaia Philip J
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA.
Gynecol Oncol. 2007 Mar;104(3):636-41. doi: 10.1016/j.ygyno.2006.10.004. Epub 2006 Nov 7.
To determine the importance of margin status and other prognostic factors associated with the recurrence and survival of patients with squamous cell vulvar carcinoma.
Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression. All slides were re-reviewed by two gynecologic pathologists.
Ninety patients (median age: 69) were treated for vulvar carcinoma from 1984 to 2002, including 28 FIGO stage I, 20 stage II, 26 stage III and 16 with stage IV disease. Sixty-three (70%) patients underwent complete radical vulvectomies and 27 (30%) had modified radical vulvectomies. Nineteen (20%) patients received adjuvant radiotherapy. Five-year disease-specific survival rates were 100%, 100%, 86% and 29% for stages I-IV, respectively. None of the 30 patients with a pathologic margin distance >8 mm had local recurrence. Of the 53 women with tumor-free pathologic margin of <8 mm, 12 (23%) had a local recurrence. Moreover, women with >2 positive groin nodes had significantly higher recurrence risk compared to those with <2 metastatic groin nodes (p<0.001). On multivariate analysis, positive groin nodes and margin distance were important prognostic factors for recurrence. Moreover, stage, tumor size, margin distance, and depth of invasion were significant independent predictors for disease-specific survival. The median follow-up was 58 months (range: 2-188).
Pathologic margin distance is an important predictor of local vulvar recurrence. Our data suggest that a > or =8-mm pathologic margin clearance leads to a high rate of loco-regional control.
确定切缘状态及其他与外阴鳞状细胞癌患者复发和生存相关的预后因素的重要性。
采用Kaplan-Meier法和Cox比例风险回归分析数据。所有切片均由两名妇科病理学家重新审查。
1984年至2002年期间，90例患者（中位年龄：69岁）接受了外阴癌治疗，其中FIGO I期28例，II期20例，III期26例，IV期16例。63例（70%）患者接受了根治性外阴切除术，27例（30%）接受了改良根治性外阴切除术。19例（20%）患者接受了辅助放疗。I-IV期患者的5年疾病特异性生存率分别为100%、100%、86%和29%。30例病理切缘距离>8 mm的患者均无局部复发。53例病理切缘无肿瘤且<8 mm的女性中，12例（23%）出现局部复发。此外，腹股沟淋巴结转移>2枚的女性与腹股沟淋巴结转移<2枚的女性相比，复发风险显著更高（p<0.001）。多因素分析显示，腹股沟淋巴结阳性和切缘距离是复发的重要预后因素。此外，分期、肿瘤大小、切缘距离和浸润深度是疾病特异性生存的重要独立预测因素。中位随访时间为58个月（范围：2-188个月）。
病理切缘距离是外阴局部复发的重要预测因素。我们的数据表明，病理切缘清除≥8 mm可导致较高的局部区域控制率。
