University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, The Netherlands.
Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, The Netherlands.
Gynecol Oncol. 2018 Mar;148(3):622-631. doi: 10.1016/j.ygyno.2017.11.006. Epub 2017 Nov 12.
In patients treated for early-stage squamous cell vulvar carcinoma local recurrence is reported in up to 40% after ten years. Knowledge on prognostic factors related to local recurrences should be helpful to select high risk patients and/or to develop strategies to prevent local recurrences.
This systematic review aims to evaluate the current knowledge on the incidence of local recurrences in vulvar carcinoma related to clinicopathologic and cell biologic variables.
Relevant studies were identified by an extensive online electronic search in July 2017.
Studies reporting prognostic factors specific for local recurrences of vulvar carcinoma were included.
Two review authors independently performed data selection, extraction and assessment of study quality. The risk difference was calculated for each prognostic factor when described in two or more studies.
Twenty-two studies were included; most of all were retrospective and mainly reported pathologic prognostic factors. Our review indicates an estimated annual local recurrence rate of 4% without plateauing. The prognostic relevance for local recurrence of vulvar carcinoma of all analyzed variables remains equivocal, including pathologic tumor free margin distance <8mm, presence of lichen sclerosus, groin lymph node metastases and a variety of primary tumor characteristics (grade of differentiation, tumor size, tumor focality, depth of invasion, lymphovascular space invasion, tumor localization and presence of human papillomavirus).
Current quality of data on prognostic factors for local recurrences in vulvar carcinoma patients does not allow evidence-based clinical decision making. Further research on prognostic factors, applying state of the art methodology is needed to identify high-risk patients and to develop alternative primary and secondary prevention strategies.
在接受早期鳞状细胞外阴癌治疗的患者中，十年后局部复发的比例高达 40%。了解与局部复发相关的预后因素有助于选择高危患者和/或制定预防局部复发的策略。
本系统评价旨在评估与临床病理和细胞生物学变量相关的外阴癌局部复发的发生率方面的现有知识。
2017 年 7 月，通过广泛的在线电子搜索确定了相关研究。
纳入报告外阴癌局部复发的特定预后因素的研究。
两名综述作者独立进行数据选择、提取和研究质量评估。当在两项或更多研究中描述时，计算每个预后因素的风险差异。
共纳入 22 项研究；大多数为回顾性研究，主要报告病理预后因素。我们的综述表明，局部复发的年估计率为 4%，且无平台期。所有分析变量对外阴癌局部复发的预后相关性仍存在争议，包括病理切缘无肿瘤距离<8mm、存在硬化性苔藓、腹股沟淋巴结转移以及各种原发性肿瘤特征（分化程度、肿瘤大小、肿瘤局灶性、浸润深度、淋巴管血管间隙浸润、肿瘤定位和人乳头瘤病毒存在）。
目前关于外阴癌患者局部复发预后因素的数据质量尚不能为临床决策提供依据。需要进一步研究预后因素，应用最先进的方法，以确定高危患者，并制定替代的初级和二级预防策略。
