Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, China.
Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
Int J Clin Oncol. 2021 Apr;26(4):784-793. doi: 10.1007/s10147-020-01838-z. Epub 2021 Jan 1.
The management for patients with vulvar cancer after sentinel lymph-node biopsy (SLNB) remains controversial. The aim of this study was to investigate the long-term outcomes of individualized management after SLNB for early stage vulvar cancer.
The medical records of patients with vulvar cancer treated by surgery involving SLNB between 2004 and 2019 were retrospectively reviewed. During this period, the inguinofemoral lymphadenectomy (IL) were performed with individualized strategy, while the postoperative intensity-modulated radiotherapy was planned with a consistent policy.
We identified 138 patients with at least one sentinel node detected, of whom 64 underwent further IL while 74 had SLNB only. Nodal metastases (pN+) were confirmed in 22 patients with IL and 16 without. Radiotherapy was scheduled with the dose of 60-70 Gy for all pN+ patients and finally completed in 15 with IL and 15 without. The median follow-up time was 56 months (6-156 months). Recurrence was observed in 24 patients, of whom 10 were pN- at primary treatment. The 3-year overall survival (OS) was 97.2, 95.2, 68.3, and 71.8%; 3-year disease-free survival (DFS) was 94.5, 91.4, 60.2, and 59.2%, respectively, for patients with pN- and IL, pN- and SLNB, pN+ and IL, and pN+ and SLNB. Neither OS nor DFS showed significant difference between SLNB and IL in pN- (P = 0.564 for OS, P = 0.423 for DFS), or pN + patients (P = 0.920 for OS, P = 0.862 for DFS).
With appropriate adjuvant radiotherapy, SLNB alone provided similar long-term survival compared with IL for both patients with and without sentinel node metastasis.
外阴癌患者行前哨淋巴结活检（SLNB）后的处理仍存在争议。本研究旨在探讨 SLNB 后对早期外阴癌患者进行个体化管理的长期结果。
回顾性分析 2004 年至 2019 年间行手术治疗且包含 SLNB 的外阴癌患者的病历资料。在此期间，采用个体化策略进行腹股沟-股部淋巴结清扫术（IL），同时采用一致的策略规划术后调强放疗。
共纳入 138 例至少有 1 枚前哨淋巴结检出的患者，其中 64 例行进一步 IL，74 例行 SLNB 仅。22 例行 IL 的患者和 16 例行 SLNB 仅的患者中证实存在淋巴结转移（pN+）。所有 pN+患者均接受 60-70 Gy 的放疗，最终 15 例行 IL 的患者和 15 例行 SLNB 仅的患者完成了放疗。中位随访时间为 56 个月（6-156 个月）。24 例患者出现复发，其中 10 例在初次治疗时为 pN-。3 年总生存率（OS）分别为 97.2%、95.2%、68.3%和 71.8%；3 年无病生存率（DFS）分别为 94.5%、91.4%、60.2%和 59.2%，分别为 pN-且行 IL、pN-且行 SLNB、pN+且行 IL 和 pN+且行 SLNB 的患者。pN-患者中 SLNB 与 IL 之间的 OS（P=0.564）和 DFS（P=0.423）差异均无统计学意义，pN+患者的 OS（P=0.920）和 DFS（P=0.862）也无统计学意义。
对于有或无前哨淋巴结转移的患者，适当的辅助放疗后，单独行 SLNB 与 IL 相比，可获得相似的长期生存。
