外阴癌中的神经周围侵犯：421 例回顾。

Perineural invasion (PNI) in vulvar carcinoma: A review of 421 cases.

机构信息

The Department of Obstetrics & Gynecology, Federal University of Health Sciences/Irmandade Santa Casa de Misericordia, Porto Alegre, Brazil; Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

出版信息

Gynecol Oncol. 2019 Jan;152(1):101-105. doi: 10.1016/j.ygyno.2018.10.035. Epub 2018 Nov 3.

DOI:10.1016/j.ygyno.2018.10.035

PMID:30396690

Abstract

OBJECTIVES

To evaluate the prevalence and associated prognostic indicators in patients with vulvar carcinoma with and without evidence of perineural invasion (PNI).

METHODS

A retrospective review identified 421 patients with invasive vulvar carcinoma evaluated at a single institution between 1993 and 2011. Medical records were reviewed for demographic data, pathologic information and presence or absence of PNI, treatment type, and recurrence/outcome information. Variables were compared between patients with PNI to those without PNI.

RESULTS

Of the 421 patients included in the study, 32 (7.6%) had tumors with PNI. There were no significant differences in age, race/ethnicity, smoking history, histologic subtype, or grade between the group of patients with PNI and the group without PNI. The group with PNI was more likely to have lichen sclerosus (25.0% vs. 15.4%, p = 0.024), stage III/IV disease (59.4% vs. 36.0%, p = 0.007), lymph node involvement (50.0% vs. 21.6%, p = 0.002), and lymphovascular space invasion (LVSI) (53.1% vs. 15.9%, p < 0.001). A higher proportion of patients in the PNI group underwent primary or adjuvant radiation therapy (68.8% vs. 45.0%, p = 0.016). The median follow-up was 67.1 months (range < 1.0 to 284.3). Patients with PNI had significantly shorter overall survival (OS), median 25.5 vs. 94.3 months (p < 0.001), and progression-free survival (PFS), median 17.5 vs. 29.0 months (p = 0.004). After adjusting for stage, patients with PNI had a greater risk for death and progression (OS: hazard ratio, 2.71; p < 0.001; PFS: hazard ratio, 1.64; p-value = 0.020).

CONCLUSION

PNI should be considered an independent poor prognostic factor for patients with vulvar carcinoma, and should be included as part of the pathologic analysis.

摘要

目的

评估外阴癌患者中存在和不存在神经周围侵犯（PNI）的患病率及相关预后指标。

方法

回顾性分析了 1993 年至 2011 年间在一家机构接受评估的 421 例浸润性外阴癌患者的病历。回顾了患者的人口统计学数据、病理信息以及 PNI 的存在或缺失、治疗类型和复发/结果信息。将有 PNI 的患者与无 PNI 的患者进行了比较。

结果

在纳入本研究的 421 例患者中，32 例（7.6%）肿瘤存在 PNI。PNI 组与无 PNI 组之间在年龄、种族/民族、吸烟史、组织学亚型或分级方面无显著差异。PNI 组更可能患有硬化性苔藓（25.0% vs. 15.4%，p=0.024）、III/IV 期疾病（59.4% vs. 36.0%，p=0.007）、淋巴结受累（50.0% vs. 21.6%，p=0.002）和淋巴管血管间隙浸润（LVSI）（53.1% vs. 15.9%，p<0.001）。PNI 组中有更高比例的患者接受了原发性或辅助性放疗（68.8% vs. 45.0%，p=0.016）。中位随访时间为 67.1 个月（范围<1.0-284.3）。PNI 患者的总生存期（OS）和无进展生存期（PFS）明显更短，中位 OS 分别为 25.5 个月和 94.3 个月（p<0.001），中位 PFS 分别为 17.5 个月和 29.0 个月（p=0.004）。在调整了分期后，PNI 患者的死亡和进展风险更高（OS：风险比，2.71；p<0.001；PFS：风险比，1.64；p 值=0.020）。