外阴鳞状细胞癌治疗中的预后变量。

Shimm D S, Fuller A F, Orlow E L, Dosoretz D E, Aristizabal S A

Gynecol Oncol. 1986 Jul;24(3):343-58. doi: 10.1016/0090-8258(86)90312-4.

Records of 98 patients undergoing surgery for squamous cell carcinoma of the vulva between 1960 and 1982 were analyzed to evaluate and develop treatment policy. There were 32, 34, 26, and 6 patients in FIGO stages I-IV, respectively. Eighty-six patients underwent radical vulvectomy, 8 patients underwent less extensive procedures, and 4 underwent more extensive procedures. Eighty-seven patients underwent inguinal node dissection, and 40 underwent pelvic node dissection as well. Eight patients received external beam irradiation. Actuarial 5-year survival was 57%. Age, tumor size, FIGO (clinical) stage, surgically determined T and N stages, tumor differentiation, lymph vessel invasion, extent of surgical procedure, and adjuvant irradiation were analyzed to determine their effects on local control, freedom from distant metastases, and survival, using single variable and multivariate analysis. Local control was significantly related to FIGO stage; freedom from distant metastasis was significantly related to surgical N stage, tumor size, and surgical T stage; survival was significantly related to surgical N stage, tumor size, surgical T stage, age, and lymph vessel invasion. Metastatic involvement of inguinal lymph nodes was significantly correlated with tumor size and differentiation. Of 87 evaluable patients, 33 had inguinal node involvement, and of these, 17 developed recurrent disease. All 7 patients with pelvic node metastases had positive inguinal nodes, and all died; the cause of death could be determined in 5, of whom 4 manifested distant metastases. Pelvic lymphadenectomy conferred no survival benefit in this series, even in the presence of positive inguinal nodes. Local vulvar recurrence is a significant problem in patients with positive inguinal nodes, and postoperative irradiation should be directed to this area in these patients. Patients with vulvar recurrences, especially those occurring at least 2 years after surgery, can be successfully salvaged, and should therefore be treated aggressively.

分析了1960年至1982年间98例接受外阴鳞状细胞癌手术患者的记录，以评估并制定治疗策略。国际妇产科联盟（FIGO）分期I - IV期的患者分别有32例、34例、26例和6例。86例患者接受了根治性外阴切除术，8例患者接受了范围较小的手术，4例患者接受了范围更大的手术。87例患者接受了腹股沟淋巴结清扫术，其中40例还接受了盆腔淋巴结清扫术。8例患者接受了体外照射。5年精算生存率为57%。采用单变量和多变量分析方法，对年龄、肿瘤大小、FIGO（临床）分期、手术确定的T和N分期、肿瘤分化程度、淋巴管浸润、手术范围以及辅助放疗进行分析，以确定它们对局部控制、无远处转移和生存的影响。局部控制与FIGO分期显著相关；无远处转移与手术N分期、肿瘤大小和手术T分期显著相关；生存与手术N分期、肿瘤大小、手术T分期、年龄和淋巴管浸润显著相关。腹股沟淋巴结转移与肿瘤大小和分化程度显著相关。在87例可评估患者中，33例有腹股沟淋巴结受累，其中17例出现复发性疾病。所有7例盆腔淋巴结转移患者的腹股沟淋巴结均为阳性，且全部死亡；5例患者的死因可以确定，其中4例表现为远处转移。在本系列研究中，即使腹股沟淋巴结阳性，盆腔淋巴结清扫术也未带来生存益处。腹股沟淋巴结阳性患者的局部外阴复发是一个重要问题，这些患者术后放疗应针对该区域。外阴复发患者，尤其是术后至少2年出现复发的患者，可以成功挽救，因此应积极治疗。