Matsuo Koji, Whitman Stephanie A, Blake Erin A, Conturie Charlotte L, Ciccone Marcia A, Jung Carrie E, Takiuchi Tsuyoshi, Nishimura Masato
Division of Gynecology Oncology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA.
Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:216-23. doi: 10.1016/j.ejogrb.2014.04.017. Epub 2014 Apr 19.
Vulvar cancer is an extremely rare complication during pregnancy, and its effect on pregnancy and survival is not well understood. A systematic literature review was conducted in order to examine the fetal and maternal outcomes and optimal management of pregnancy complicated by vulvar cancer. PubMed/MEDLINE were used to identify case reports with searching keywords "pregnancy" and "vulvar cancer" between January 1955 and February 2014 that identified 36 cases for analysis. Mean age was 30.7. The most common presenting symptom and gestational age were vulvar mass/swelling (75.0%) and the second trimester of pregnancy (54.8%), respectively. Vulvar biopsy at the time of initial presentation to care during pregnancy was performed in only 46.7% of cases. Among delayed cases for biopsy, mean duration of delay was 12.8 weeks and the majority had a delay for more than 8 weeks (62.5%). The majority of vulvar cancer was squamous histology (47.2%) and stage I disease (60.0%). Vulvectomy and inguinal-femoral lymphadenectomy were performed in 97.1% and 63.9%, respectively. Abdominal delivery was recorded in 46.2% of cases. Live birth and full term delivery rates were 96.3% and 74.0%, respectively. For survival analysis, delay in diagnosis and advanced stage disease were commonly associated with decreased disease-free survival (5-year rate, delay in diagnosis >8 versus ≤8 weeks, 0% versus 69.1%, hazard ratio (HR) 7.86, 95% confidence interval (CI) 2.03-30.6, p=0.001; and stage III-IV versus stage I-II, 0% versus 59.8%, HR 3.35, 95% CI 1.16-9.68, p=0.011) and overall survival (5-year rate, delay in diagnosis >8 versus ≤8 weeks, 0% versus 67.1%, hazard ratio (HR) 14.8, 95% CI 1.77-124, p=0.001; and stage III-IV versus stage I-II, 0% versus 86.4%, HR 8.22, 95% CI 2.06-33.2, p<0.001). In conclusion, while the majority of cases resulted in good pregnancy outcomes, diagnosis of vulvar cancer during pregnancy is frequently delayed. Since delayed diagnosis is a significant prognosticator of decreased survival outcomes, early recognition is integral in the management of pregnancy complicated by vulvar cancer.
外阴癌是妊娠期极为罕见的并发症，其对妊娠及生存的影响尚未完全明确。为了研究妊娠合并外阴癌的胎儿及母体结局和最佳管理方式，我们进行了一项系统的文献综述。使用PubMed/MEDLINE检索1955年1月至2014年2月期间包含关键词“妊娠”和“外阴癌”的病例报告，共识别出36例用于分析。平均年龄为30.7岁。最常见的临床表现症状和孕周分别是外阴肿物/肿胀（75.0%）和妊娠中期（54.8%）。仅46.7%的病例在孕期初次就诊时进行了外阴活检。在延迟活检的病例中，平均延迟时间为12.8周，大多数延迟超过8周（62.5%）。大多数外阴癌为鳞状组织学类型（47.2%）且为I期疾病（60.0%）。分别有9
