Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States of America.
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States of America.
Gynecol Oncol. 2022 Jul;166(1):61-68. doi: 10.1016/j.ygyno.2022.05.001. Epub 2022 May 9.
The management of vulvar cancer with clinically negative groin lymph nodes but with positive sentinel lymph node biopsy (SLNB) is controversial, with options including inguinofemoral lymphadenectomy (IFL) and/or adjuvant chemotherapy and radiotherapy. We used the National Cancer Database (NCDB) to examine trends in the management of clinically node negative, pathologically node positive (cN-/pN+) patients.
The NCDB was used to identify cN-/pN+ vulvar cancer patients. Demographic and clinical data were compared with chi-squared and Wilcoxon rank-sum tests. OS was analyzed with the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was used to determine factors associated with OS.
A total of 885 cN-/pN+ vulvar cancer patients were identified between 2012 and 2016, during which the rate of SLNB alone increased from 3.6% to 11.7%, while the rate of IFL +/- SLNB decreased from 89.7% to 78.1% (p < 0.05). Radiation was used in 68.5% and 64.6% of the SLNB-alone and IFL +/- SLNB cohorts, respectively, with chemoradiation in 37.1% and 33.6%, respectively. OS was not different between patients who received SLNB-alone vs. IFL +/- SLNB (p = 0.644). Receipt of chemotherapy and radiation was associated with improved OS (p < 0.001).
Among cN-/pN+ vulvar cancer patients in the NCDB, the practice of performing IFL decreased over time as SLNB-alone became more common and the majority received radiation +/- chemotherapy. There was no difference in OS between SLNB-alone vs. IFL +/- SLNB. Patients treated with adjuvant chemoradiation had improved survival. Whether the favorable outcomes in the SLNB-alone cohort may be attributed to radiotherapy dose escalation or use of chemotherapy warrants further study.
对于临床腹股沟淋巴结阴性但前哨淋巴结活检（SLNB）阳性的外阴癌患者，其管理存在争议，可选择的方法包括腹股沟-股部淋巴结清扫术（IFL）和/或辅助化疗和放疗。我们使用国家癌症数据库（NCDB）来研究临床淋巴结阴性、病理淋巴结阳性（cN-/pN+）患者管理方式的变化趋势。
我们使用 NCDB 来识别 cN-/pN+外阴癌患者。使用卡方检验和 Wilcoxon 秩和检验比较人口统计学和临床数据。使用 Kaplan-Meier 方法和对数秩检验分析 OS。使用 Cox 比例风险回归确定与 OS 相关的因素。
在 2012 年至 2016 年间，共确定了 885 例 cN-/pN+外阴癌患者，在此期间，单独行 SLNB 的比例从 3.6%增加到 11.7%，而行 IFL +/- SLNB 的比例从 89.7%下降到 78.1%（p < 0.05）。单独行 SLNB 组和 IFL +/- SLNB 组分别有 68.5%和 64.6%的患者接受了放疗，分别有 37.1%和 33.6%的患者接受了放化疗。单独行 SLNB 组和 IFL +/- SLNB 组之间的 OS 没有差异（p = 0.644）。接受化疗和放疗与 OS 改善相关（p < 0.001）。
在 NCDB 中的 cN-/pN+外阴癌患者中，随着单独行 SLNB 变得更为常见，同时 IFL 的应用逐渐减少，大多数患者接受了放疗 +/- 化疗。单独行 SLNB 与 IFL +/- SLNB 之间的 OS 没有差异。接受辅助放化疗的患者生存状况得到改善。单独行 SLNB 组的良好结果是否归因于放疗剂量的增加或化疗的应用，还需要进一步研究。
