*Departments of Gynecology, †Pathology, ‡Medical Statistics, and §Clinical Oncology, Leiden University Medical Center, Leiden, TheNetherlands.
Int J Gynecol Cancer. 2013 Oct;23(8):1476-83. doi: 10.1097/IGC.0b013e3182a57fd6.
To identify clinical characteristics associated with recurrence and progression in patients with usual vulvar intraepithelial neoplasia (uVIN), which may function as prognostic factors and aid in the treatment of patients with human papillomavirus (HPV)-related disease of the genital tract.
A retrospective chart review was performed in 73 patients with uVIN treated at the Leiden University Medical Center between 1990 and 2012. All medical records were reviewed for demographics, treatment type, pathology reports, and recurrence and progression rates.
The mean age of diagnosis was 43 years, and uVIN was symptomatic in 60.1% of the patients. The median follow-up time was 49 months. High-risk HPV was found in 86.3% of the patients. Smoking was reported in 76.8% of the patients. Eleven of 73 patients were immune compromised. Multicentric HPV-related disease of the cervix or vagina was reported in 75.3% of the patients. Recurrences were diagnosed in 50.7% of the patients after first treatment type that consisted of excision (45.2%), laser (34.2%), imiquimod (8.2%), and combination of excision and laser (12.3%). Higher recurrence rates were only correlated with multifocality of uVIN lesions. Excision, imiquimod therapy, and unifocal lesions showed an increased recurrence-free survival. Human papillomavirus type, smoking, multicentric disease, use of topical steroids, and positive surgical borders were not related to a shorter recurrence-free survival. Progression into vulvar carcinoma occurred in 11 (15.1%) of the patients, 4 of whom were immune compromised. These patients showed a shorter progression-free survival of 54 versus 71.5 months.
There are no clinical characteristics that form prognostic factors in uVIN, except for multifocality of lesions, which is correlated with a higher recurrence rate. Furthermore, progression of uVIN to carcinoma was accelerated and increased in immune-compromised patients, suggesting that studies of local immunity in uVIN may reveal potentialprognostic factors and aid in the development of new treatment modalities.
确定与外阴上皮内瘤变（uVIN）患者复发和进展相关的临床特征，这些特征可能作为预后因素，并有助于治疗人乳头瘤病毒（HPV）相关的生殖道疾病。
对莱顿大学医学中心 1990 年至 2012 年间治疗的 73 例 uVIN 患者进行回顾性图表审查。回顾所有病历以获取人口统计学、治疗类型、病理报告以及复发和进展率。
诊断时的平均年龄为 43 岁，60.1%的患者有 uVIN 症状。中位随访时间为 49 个月。86.3%的患者发现高危 HPV。76.8%的患者报告吸烟。11 例患者免疫功能受损。75.3%的患者报告宫颈或阴道多中心 HPV 相关疾病。首次治疗类型为切除（45.2%）、激光（34.2%）、咪喹莫特（8.2%）和切除加激光（12.3%）后，50.7%的患者诊断出复发。较高的复发率仅与 uVIN 病变的多灶性相关。切除、咪喹莫特治疗和单灶病变显示出更高的无复发生存率。HPV 类型、吸烟、多中心疾病、局部皮质类固醇的使用和阳性手术边界与无复发生存时间较短无关。11 例（15.1%）患者进展为外阴癌，其中 4 例免疫功能受损。这些患者的无进展生存期为 54 个月，而不是 71.5 个月。
除病变的多灶性外，uVIN 没有形成预后因素的临床特征，这与较高的复发率相关。此外，免疫功能受损患者的 uVIN 向癌的进展加快并增加，这表明 uVIN 局部免疫的研究可能揭示潜在的预后因素，并有助于开发新的治疗方法。
