Gunderson Camille C, Nugent Elizabeth K, Yunker Amanda C, Rocconi Rodney P, Graybill Whitney S, Erickson Britt K, Moore Kathleen N
1Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK; and 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL.
J Low Genit Tract Dis. 2013 Oct;17(4):409-13. doi: 10.1097/LGT.0b013e3182800ee2.
Limited data regarding the natural history, management, and prognosis of vaginal cancer exist owing to the relative disease rarity.
A retrospective chart review was performed at 2 institutions to identify women receiving treatment for vaginal cancer between 1990 and 2004. Demographics, risk factors, histology, International Federation of Gynecology and Obstetrics stage, treatment, and treatment-related complications were recorded. Statistical Analysis Software (SAS) version 9.2 was used.
A total of 110 patients were identified in the 2 university databases. Median age was 63 years (range = 36-93 years), and 84% were white; 73% had squamous cell carcinoma, 40% were ever users of tobacco, and 64% had no abnormal Pap smear results. Of the patients, 83% had early-stage (I or II) disease. Treatment varied by stage with increasing use of radiation with advancing stage. Recurrence was 24%, 32%, and 53% for stage I, II, and III/IV disease, respectively. After a median follow-up of 21 months, progression-free survival was 59, 35, and 23 months for stage I, II, and III/IV disease, respectively. Overall survival was 106, 58, and 34 months for stage I, II, and III/IV disease, respectively. Age greater than 60 years (p = .0339; hazard ratio [HR] = 2.162), advanced stage (p = .0004; HR = 2.475), and tobacco use (p = .0004; HR = 1.02) were negatively associated with survival. Thirty percent developed a significant complication (fistula, stricture, cystitis, or proctitis), and 21% developed a vesicovaginal and/or rectovaginal fistula. There was no association of fistula development with age, stage, tobacco use, histological finding, or treatment history (including radiation therapy).
Age, stage, and tobacco abuse seem to be negatively associated with survival in vaginal cancer. However, no risk factors were associated with fistula development.
由于阴道癌相对罕见，关于其自然病史、治疗及预后的资料有限。
在两家机构进行回顾性病历审查，以确定1990年至2004年间接受阴道癌治疗的女性。记录人口统计学资料、危险因素、组织学类型、国际妇产科联盟分期、治疗方法及治疗相关并发症。使用统计分析软件（SAS）9.2版。
在两个大学数据库中共识别出110例患者。中位年龄为63岁（范围=36 - 93岁），84%为白人；73%为鳞状细胞癌，40%曾吸烟，64%巴氏涂片结果无异常。患者中，83%为早期（I或II期）疾病。治疗方法因分期而异，随着分期进展放疗使用增加。I期、II期和III/IV期疾病的复发率分别为24%、32%和53%。中位随访21个月后，I期、II期和III/IV期疾病的无进展生存期分别为59个月、35个月和23个月。I期、II期和III/IV期疾病的总生存期分别为106个月、58个月和34个月。年龄大于60岁（p = 0.0339；风险比[HR]=2.162）、晚期（p = 0.0004；HR = 2.475）和吸烟（p = 0.0004；HR = 1.02）与生存呈负相关。30%发生严重并发症（瘘管、狭窄、膀胱炎或直肠炎），21%发生膀胱阴道和/或直肠阴道瘘。瘘管形成与年龄、分期、吸烟、组织学结果或治疗史（包括放疗）无关。
年龄、分期和吸烟似乎与阴道癌患者的生存呈负相关。然而，没有危险因素与瘘管形成相关。
