Department of Gynecological, Obstetric and Urological Sciences, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2013 Apr;17(7):936-40.
Vulvar intraepithelial neoplasia (VIN) is a premalingnant condition. For long time, surgery was considered the first-line therapy in the treatment of high grade VIN. Imiquimod was recently introduced as an alternative to surgery.
To compare the overall complete response, the recurrence rate and the risk factors for relapse among patients with VIN 2/3 treated with Imiquimod or surgical excision.
Eighty women who had histological diagnosis of VIN 2 and VIN 3 were enrolled in this prospective study. Patients immunocompromised, with recurrent VIN, with well differentiated type VIN or VIN 1 and women treated more than once were excluded from the study. Patients were divided into two groups: group A was treated with Imiquimod, group B underwent surgical excision. Patients' characteristics analyzed were: age, smoking, degree of the primary lesion, state of margins, multifocal disease. We have evaluated the recurrence rate, the relapse rate, and the overall complete response, considering as recurrence the onset of a lesion after an initial complete response to Imiquimod and/or after the surgical treatment and as relapse all patients who had a recurrence plus those with medical treatment failure.
Multifocal lesions (p = 0.03) and VIN 3 (p = 0.002) were associated with a higher risk of relapse. The recurrence rate was higher in the group B (p = 0.009), but the relapse rate was higher in the group A (p = 0.04). The overall complete response was better in the group B (p = 0.04).
Although the advent of new medical options can decrease the morbidity associated with invasive surgical procedures, surgical treatments remain the best treatment modality for VIN with regard to relapse and overall complete response.
外阴上皮内瘤变（VIN）是一种癌前病变。长期以来，手术被认为是治疗高级别 VIN 的一线治疗方法。咪喹莫特最近被引入作为手术的替代方法。
比较 VIN 2/3 患者接受咪喹莫特或手术切除治疗的总体完全缓解率、复发率和复发相关因素。
本前瞻性研究纳入了 80 名组织学诊断为 VIN 2 和 VIN 3 的女性患者。排除免疫功能低下、复发性 VIN、分化良好型 VIN 或 VIN 1 以及多次治疗的患者。患者分为两组：A 组接受咪喹莫特治疗，B 组接受手术切除。分析患者的特征包括：年龄、吸烟、原发病变程度、边缘状态、多发病灶。我们评估了复发率、复发率和总体完全缓解率，将初始咪喹莫特治疗和/或手术治疗后的病变出现视为复发，将所有复发患者和药物治疗失败患者视为复发。
多发病灶（p=0.03）和 VIN 3（p=0.002）与更高的复发风险相关。B 组的复发率更高（p=0.009），但 A 组的复发率更高（p=0.04）。B 组的总体完全缓解率更好（p=0.04）。
尽管新的医疗选择的出现可以降低与侵入性手术相关的发病率，但就复发和总体完全缓解而言，手术治疗仍然是 VIN 的最佳治疗方法。
