Department of Radiation Oncology, Brigham and Women's Hospita and Dana-Farber Cancer Institutel, Harvard Medical School, Boston, MA, USA.
Gynecol Oncol. 2013 Sep;130(3):545-9. doi: 10.1016/j.ygyno.2013.05.036. Epub 2013 Jun 5.
To evaluate the effect of margin status and radiation dose in patients treated with radiation therapy (RT) for vulvar cancer. Clinical outcomes included vulvar recurrence (VR), relapse-free survival (RFS) and overall survival (OS).
We retrospectively reviewed the records of 300 patients with Stage I-IVA vulvar cancer treated between 1988 and 2009. Slides were reviewed and margin status was scored as negative (≥ 1 cm), close (<1cm) or positive after formalin fixation. Cox proportional hazards models were constructed to determine significant prognostic factors for vulvar relapse.
Of 205 eligible patients, 69 (34%) had negative surgical margins, 116 (56%) had close margins and 20 (10%) had positive margins. Median follow-up time was 49 months. The 4-year RFS rate was 53% and OS was 73%. Of 78 recurrences, 62 had the vulva as the first site of recurrence. The 4-year rates of freedom from vulvar recurrence were 82%, 63% and 37% for those with negative, close and positive margins, respectively (p for trend=0.005). On multivariate analysis, close margins (HR=3.03, 95% CI 1.46-6.26) and positive margins (HR=7.02, 95% CI 2.66-18.54) were associated with a significantly increased risk of vulvar relapse. Those who received a dose ≥ 56 Gy had a lower risk of relapse than those who received ≤ 50.4 Gy (p<0.05). Though recurrences were noted with margins up to 9 mm, the highest risk of vulvar recurrence was associated with margins ≤ 5 mm (p=0.002).
Close or positive margins were associated with a significantly increased risk of vulvar recurrence. Radiation with a dose ≥ 56 Gy may decrease the risk of vulvar recurrence.
评估外阴癌患者接受放射治疗（RT）时的边缘状态和辐射剂量的影响。临床结果包括外阴复发（VR）、无复发生存率（RFS）和总生存率（OS）。
我们回顾性分析了 1988 年至 2009 年间治疗的 300 例 I-IVA 期外阴癌患者的记录。对切片进行了审查，并在福尔马林固定后将边缘状态评分为阴性（≥1cm）、接近（<1cm）或阳性。构建 Cox 比例风险模型来确定外阴复发的显著预后因素。
在 205 例合格患者中，69 例（34%）有阴性手术边缘，116 例（56%）有接近边缘，20 例（10%）有阳性边缘。中位随访时间为 49 个月。4 年 RFS 率为 53%，OS 为 73%。78 例复发中有 62 例外阴为复发的首发部位。阴性、接近和阳性边缘的 4 年无外阴复发率分别为 82%、63%和 37%（趋势检验 p=0.005）。多因素分析显示，接近边缘（HR=3.03，95%CI 1.46-6.26）和阳性边缘（HR=7.02，95%CI 2.66-18.54）与外阴复发风险显著增加相关。接受剂量≥56Gy 的患者复发风险低于接受≤50.4Gy 的患者（p<0.05）。尽管在边缘高达 9mm 处仍有复发，但外阴复发的最高风险与边缘≤5mm 相关（p=0.002）。
接近或阳性边缘与外阴复发风险显著增加相关。剂量≥56Gy 的放疗可能降低外阴复发的风险。
