J Natl Compr Canc Netw. 2018 Jan;16(1):42-49. doi: 10.6004/jnccn.2017.7022.
Currently, no studies have attempted to validate the AJCC tumor (T) class for vulvar cancer or examine its performance via clinical data. The goal of this study was to identify risk factors associated with poor outcomes in vulvar squamous cell carcinoma (vSCC) and compare prognostic discrimination of these outcomes between the AJCC T-classification system and the newly developed Brigham and Women's Vulvar Tumor Classification system (BWVTC). A 15-year, 2-center retrospective cohort study of primary vSCCs (N=226) was undertaken. Risk factors for poor outcomes, including local recurrence (LR), nodal and distant metastasis (NM and DM, respectively), disease-specific death (DSD), and overall death (OD) were determined using competing risks models. Poor outcomes were analyzed by T stage with regard to each classification system's distinctiveness, homogeneity, and monotonicity. AJCC T stages were indistinct, with overlapping 95% confidence intervals for 10-year cumulative incidences of poor outcomes. Most poor outcomes occurred in low AJCC T stages: T1a/T1b contained 77% of LR, 79% of NM, 66% of DM/DSD, and 78% of OD, indicating poor homogeneity and monotonicity. Five risk factors were independent predictors of poor outcomes: history of lichen sclerosus, tumor diameter ≥2.0 cm, tumor depth ≥3.0 mm, poor differentiation, and mucosal involvement, and these were used to develop the BWVTC (BWVTC BWT1 = 0 risk factors; BWT2 = 1 risk factor; BWT3 = 2 risk factors; and BWT4 = ≥3 risk factors). The BWVTC displayed superior homogeneity and monotonicity, with most poor outcomes occurring in high T stages: T3/T4 contained 87% of LR, 92% of NM, 91% of DM/DSD, and 78% of OD (<.001), although not all T stages were statistically distinct in this small cohort. The BWVTC offers improved prognostic discrimination over the AJCC T-classification system. Validation in population-based cohorts and in vulvar cancers other than SCC is needed.
目前，尚无研究尝试验证 AJCC 肿瘤（T）分类用于外阴癌，也未通过临床数据来检验其性能。本研究的目的是确定与外阴鳞癌（vSCC）不良结局相关的危险因素，并比较 AJCC T 分类系统与新开发的布莱根妇女医院外阴肿瘤分类系统（BWVTC）对这些结局的预后判别能力。开展了一项回顾性队列研究，纳入了 226 例原发性 vSCC 患者，研究时间为 15 年，涉及 2 个中心。使用竞争风险模型确定与不良结局相关的危险因素，包括局部复发（LR）、淋巴结和远处转移（NM 和 DM，分别）、疾病特异性死亡（DSD）和总死亡（OD）。使用每个分类系统的独特性、同质性和单调性来分析 T 分期与不良结局的关系。AJCC T 分期不明显，10 年累积不良结局发生率的 95%置信区间存在重叠。大多数不良结局发生在低 AJCC T 分期：T1a/T1b 包含 77%的 LR、79%的 NM、66%的 DM/DSD 和 78%的 OD，表明同质性和单调性较差。5 个危险因素是不良结局的独立预测因素：硬化性苔藓病史、肿瘤直径≥2.0cm、肿瘤深度≥3.0mm、低分化和黏膜浸润，这些因素用于开发 BWVTC（BWVTC BWT1=0 个危险因素；BWT2=1 个危险因素；BWT3=2 个危险因素；BWT4=≥3 个危险因素）。BWVTC 显示出更好的同质性和单调性，大多数不良结局发生在高 T 分期：T3/T4 包含 87%的 LR、92%的 NM、91%的 DM/DSD 和 78%的 OD（<.001），尽管在这个小队列中并非所有 T 分期都具有统计学意义。BWVTC 提供了比 AJCC T 分类系统更好的预后判别能力。需要在基于人群的队列中以及 SCC 以外的外阴癌中进行验证。
