外阴癌前哨淋巴结：GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I 的长期随访结果
Sentinel nodes in vulvar cancer: Long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I.
机构信息
Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands.
出版信息
Gynecol Oncol. 2016 Jan;140(1):8-14. doi: 10.1016/j.ygyno.2015.09.077. Epub 2015 Sep 30.
OBJECTIVE
In 2008 GROINSS-V-I, the largest validation trial on the sentinel node (SN) procedure in vulvar cancer, showed that application of the SN-procedure in patients with early-stage vulvar cancer is safe. The current study aimed to evaluate long-term follow-up of these patients regarding recurrences and survival.
METHODS
From 2000 until 2006 GROINSS-V-I included 377 patients with unifocal squamous cell carcinoma of the vulva (T1, <4 cm), who underwent the SN-procedure. Only in case of SN metastases an inguinofemoral lymphadenectomy was performed. For the present study follow-up was completed until March 2015.
RESULTS
Themedian follow-up was 105 months (range 0–179). The overall local recurrence ratewas 27.2% at 5 years and 39.5% at 10 years after primary treatment, while for SN-negative patients 24.6% and 36.4%, and for SN-positive patients 33.2% and 46.4% respectively (p = 0.03). In 39/253 SN-negative patients (15.4%) an inguinofemoral lymphadenectomy was performed, because of a local recurrence. Isolated groin recurrence rate was 2.5% for SN-negative patients and 8.0% for SN-positive patients at 5 years. Disease-specific 10-year survival was 91% for SN-negative patients compared to 65% for SN-positive patients (p b .0001). For all patients, 10-year disease-specific survival decreased from 90% for patients without to 69% for patients with a local recurrence (p b .0001).
目的
2008 年 GROINSS-V-I 是最大的外阴癌前哨淋巴结（SN）程序验证试验，表明在外阴癌早期患者中应用 SN 程序是安全的。本研究旨在评估这些患者的长期随访结果，包括复发和生存情况。
方法
2000 年至 2006 年，GROINSS-V-I 纳入了 377 例单侧局限性外阴鳞癌（T1，<4cm）患者，这些患者均接受了 SN 程序。仅在 SN 转移的情况下才进行腹股沟-股部淋巴结清扫术。本研究的随访时间截至 2015 年 3 月。
结果
中位随访时间为 105 个月（范围 0-179）。原发性治疗后 5 年和 10 年的总局部复发率分别为 27.2%和 39.5%，而 SN 阴性患者的局部复发率分别为 24.6%和 36.4%，SN 阳性患者的局部复发率分别为 33.2%和 46.4%（p=0.03）。在 253 例 SN 阴性患者中，有 39 例（15.4%）因局部复发而行腹股沟-股部淋巴结清扫术。SN 阴性患者的腹股沟复发率为 2.5%，SN 阳性患者的腹股沟复发率为 8.0%，5 年时分别为 2.5%和 8.0%。SN 阴性患者的 10 年疾病特异性生存率为 91%，而 SN 阳性患者为 65%（p<0.0001）。对于所有患者，无局部复发患者的 10 年疾病特异性生存率为 90%，而有局部复发患者的 10 年疾病特异性生存率为 69%（p<0.0001）。
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