Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 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, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Gynecol Oncol. 2021 Mar;160(3):748-754. doi: 10.1016/j.ygyno.2020.12.023. Epub 2020 Dec 29.
To examine the association between surgical margin status and recurrence pattern in invasive vulvar Paget's disease.
This is a preplanned secondary analysis of a previously organized nationwide retrospective study in Japan (JGOG-1075S). Women with stage I-IV invasive vulvar Paget's disease who received surgical treatment from 2001-2010 were examined (n=139). Multivariable analysis was performed to assess local-recurrence, distant-recurrence, and all-cause mortality based on surgical margin status.
The median age was 70 years. The majority had stage I disease (61.2%), and the median tumor size was 5.0cm. Nodal metastasis was observed in 15.1%. Simple vulvectomy (46.0%) was the most common surgery type followed by radical vulvectomy (28.1%). More than half received vulvar reconstructive surgery (59.0%). Positive surgical margin was observed in 35.3%, and close margin <1cm was observed in 29.5%. Vulvectomy type was not associated with surgical margin status (P=0.424). The median follow-up was 5.8 years. Positive surgical margin was associated with increased local-recurrence (5-year cumulative rates for positive versus negative margin: 35.8% versus 15.0%, P=0.010) but not distant-recurrence (18.3% versus 16.0%, P=0.567). Positive surgical margin was also associated with increased all-cause mortality (5-year overall survival rates for positive versus negative margin: 72.6% versus 88.2%, P=0.032). In multivariable analysis, positive surgical margin remained an independent factor associated with increased risk of local-recurrence (hazard ratio 2.80, 95% confidence interval 1.18-6.63) and all-cause mortality (hazard ratio 2.87, 95% confidence interval 1.20-6.83).
Positive surgical margin appears to be common in invasive vulvar Paget's disease that is associated with increased local-recurrence and all-cause mortality risks. Role of alternative surgical technique or adjuvant therapy merits further investigation to improve local disease control.
探讨浸润性外阴派杰病的手术切缘状态与复发模式之间的关系。
这是在日本（JGOG-1075S）进行的一项先前组织的全国性回顾性研究的预先计划的二次分析。检查了 2001-2010 年间接受手术治疗的 I-IV 期浸润性外阴派杰病女性（n=139）。基于手术切缘状态，采用多变量分析评估局部复发、远处复发和全因死亡率。
中位年龄为 70 岁。大多数患者为 I 期疾病（61.2%），肿瘤大小中位数为 5.0cm。15.1%的患者发生淋巴结转移。最常见的手术类型是单纯外阴切除术（46.0%），其次是根治性外阴切除术（28.1%）。超过一半的患者接受了外阴重建手术（59.0%）。阳性切缘占 35.3%，切缘<1cm 占 29.5%。外阴切除术类型与手术切缘状态无关（P=0.424）。中位随访时间为 5.8 年。阳性切缘与局部复发增加相关（阳性切缘与阴性切缘的 5 年累积复发率：35.8%比 15.0%，P=0.010），但与远处复发无关（18.3%比 16.0%，P=0.567）。阳性切缘也与全因死亡率增加相关（阳性切缘与阴性切缘的 5 年总生存率：72.6%比 88.2%，P=0.032）。多变量分析显示，阳性切缘仍然是与局部复发风险增加相关的独立因素（风险比 2.80，95%置信区间 1.18-6.63）和全因死亡率（风险比 2.87，95%置信区间 1.20-6.83）。
浸润性外阴派杰病中阳性切缘似乎很常见，与局部复发和全因死亡风险增加相关。替代手术技术或辅助治疗的作用值得进一步研究，以提高局部疾病控制率。
