Sana Klinikum Remscheid, Germany.
Gynecol Oncol. 2012 Jan;124(1):87-91. doi: 10.1016/j.ygyno.2011.09.014. Epub 2011 Oct 10.
Vulvar carcinomas are rare genital malignancies. While advanced primary cancer chemoradiation is often preferred over pelvic exenteration (PE), PE is often the only therapy available in cases of recurrence. In a retrospective study, we analyzed predictive factors and outcomes of patients who underwent exenteration for vulvar cancer in our department during the past 10 years.
We identified 27 patients; 9 of them suffered from primary disease, and 18 had experienced a recurrence. A total of 18 patients presented with stage FIGO III, and 9 patients presented with stage IV. In 10 patients, the disease had spread to the inguinal lymph nodes, and in 3 patients, it had also spread to the pelvic nodes. At the end of surgery, all patients were macroscopically tumor free, which was confirmed microscopically in 20 patients (74%, R0), with the other 7 patients having microscopic tumor remnants. For all patients, median time of survival was 37 months, the five-year survival rate (5YSR) was 62%, and the overall survival (OS) was 59%. Patients with tumor-free lymph nodes had an OS of 76% and a 5YSR of 83% vs. 40% and 36%, respectively, for patients with tumorous spread to the nodes (p=0.03). The 5YSR correlated to the degree of resection (R0 vs. R1, 74% vs. 21%, p=0.01).
PE is a therapeutic option in advanced primary or relapsed vulvar carcinoma, offering median- to long-term survival for many patients. Carcinomatous spread to regional lymph nodes and complete resection are the most important prognostic factors.
外阴癌是罕见的生殖系统恶性肿瘤。虽然晚期原发性癌症放化疗通常优于盆腔切除术（PE），但在复发的情况下，PE 通常是唯一可用的治疗方法。在一项回顾性研究中，我们分析了过去 10 年来在我们科室接受外阴癌切除术的患者的预测因素和结果。
我们共确定了 27 例患者；其中 9 例为原发性疾病，18 例为复发。共有 18 例患者为 FIGO III 期，9 例患者为 IV 期。10 例患者的疾病已扩散至腹股沟淋巴结，3 例患者的疾病已扩散至盆腔淋巴结。在手术结束时，所有患者均无肉眼肿瘤残留，20 例患者（74%，R0）显微镜下证实无肿瘤残留，其余 7 例患者有显微镜下肿瘤残留。所有患者的中位生存时间为 37 个月，5 年生存率（5YSR）为 62%，总生存率（OS）为 59%。无淋巴结转移的患者 OS 为 76%，5YSR 为 83%，而淋巴结转移的患者 OS 为 40%，5YSR 为 36%（p=0.03）。5YSR 与切除程度相关（R0 与 R1，74%与 21%，p=0.01）。
PE 是晚期原发性或复发性外阴癌的一种治疗选择，可为许多患者提供中至长期生存。淋巴结转移和完全切除是最重要的预后因素。
