Rouzier Roman, Preti Mario, Sideri Mario, Paniel Bernard-Jean, Jones Ronald W
Department of Gynecology, UPMC University Paris 06, UPRES EA 4053, F-75005, Paris, France.
Gynecol Oncol. 2008 Jul;110(1):83-6. doi: 10.1016/j.ygyno.2008.03.001. Epub 2008 Apr 24.
FIGO Stage III vulvar cancer includes tumors that invade the lower urethra, vagina, or anus, and/or tumors that have metastasized to the inguino-femoral lymph nodes of one groin. We hypothesized that locally advanced stage III vulvar cancer and regional metastatic stage III vulvar cancer (lymph node involvement) have different prognoses.
Using the Surveillance, Epidemiology, and End Results (SEER) registry public use data tapes, we identified patients diagnosed with vulvar carcinoma from 1988 through 2004. Overall survival (OS) was measured as the time from diagnosis to the date of death or last follow-up. We used the Kaplan-Meier method to estimate OS and the log-rank test to assess for differences between patient groups. The staging performance was quantified with respect to discrimination.
The study cohort included 895 patients. The survival difference between stage III patients with locally advanced vulvar cancer and stage III patients with regional metastatic node(s) disease was highly significant (P<10(-10)). The 5-year and 10-year OS of patients with locally advanced vulvar tumors without metastatic nodes were 62% and 47%, respectively. The 5-year and 10-year OS of patients with regional metastatic node(s) disease were 39% and 27%, respectively. Separating locally advanced stage III and regional metastatic stage III disease would improve discrimination (concordance index: 72% vs 69% with the actual staging system).
Involvement of the inguinal lymph nodes in FIGO (1988) stage III patients carries a significantly worse prognosis compared with invasion of the lower urethra, vagina or anus alone. This difference in prognosis would favor restaging these two entities.
国际妇产科联盟（FIGO）III期外阴癌包括侵犯下尿道、阴道或肛门的肿瘤，和/或已转移至一侧腹股沟腹股沟股淋巴结的肿瘤。我们假设局部晚期III期外阴癌和区域转移III期外阴癌（淋巴结受累）有不同的预后。
利用监测、流行病学和最终结果（SEER）登记处的公开使用数据磁带，我们确定了1988年至2004年期间被诊断为外阴癌的患者。总生存期（OS）定义为从诊断到死亡日期或最后一次随访的时间。我们使用Kaplan-Meier方法估计总生存期，并使用对数秩检验评估患者组之间的差异。分期表现通过鉴别能力进行量化。
研究队列包括895名患者。局部晚期外阴癌的III期患者与有区域转移淋巴结疾病的III期患者之间的生存差异非常显著（P<10⁻¹⁰）。无转移淋巴结的局部晚期外阴肿瘤患者的5年和10年总生存率分别为62%和47%。有区域转移淋巴结疾病的患者的5年和10年总生存率分别为39%和27%。区分局部晚期III期和区域转移III期疾病将提高鉴别能力（一致性指数：实际分期系统为72%对69%）。
与仅侵犯下尿道、阴道或肛门相比，FIGO（1988年）III期患者腹股沟淋巴结受累的预后明显更差。这种预后差异有利于对这两种情况重新分期。
