Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy.
Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy.
Maturitas. 2023 Sep;175:107767. doi: 10.1016/j.maturitas.2023.04.010. Epub 2023 May 3.
Vulvar lichen sclerosus is a chronic inflammatory disease involving vulvar skin. The risk of developing invasive vulvar cancer for women with LS is reported in the literature, but the risk of extra-vulvar tumors has been under-investigated. This multicentric study aims to estimate the risk of developing cancers in a cohort of women with a diagnosis of vulvar lichen sclerosus.
A cohort of women diagnosed with and treated for vulvar lichen sclerosus in three Italian gynecological and dermatological clinics (Turin, Florence, and Ferrara) was retrospectively reviewed. Patient data were linked to cancer registries of the respective regions. The risk of subsequent cancer was estimated by dividing the number of observed and expected cases by the standardized incidence ratio.
Among 3414 women with a diagnosis of vulvar lichen sclerosus corresponding to 38,210 person-years of follow-up (mean 11.2 years) we identified 229 cancers (excluding skin cancers and tumors present at the time of diagnosis). We found an increased risk of vulvar cancer (standardized incidence ratio = 17.4; 95 % CL 13.4-22.7), vaginal cancer (standardized incidence ratio = 2.7; 95 % CL 0.32-9.771), and oropharyngeal cancer (standardized incidence ratio = 2.5; 95 % CL 1.1-5.0), and a reduced risk of other gynecological tumors (cervical, endometrial, ovarian) and breast cancer.
Patients with vulvar lichen sclerosus should undergo annual gynecological check-up with careful evaluation of the vulva and vagina. The increased risk of oropharyngeal cancer also suggests the need to investigate oropharyngeal cavity symptoms and lesions in patients with vulvar lichen sclerosus.
评估诊断为外阴硬化性苔藓（LS）女性队列发生癌症的风险。
回顾性分析了意大利三家妇科和皮肤科诊所（都灵、佛罗伦萨和费拉拉）诊断和治疗的外阴硬化性苔藓女性患者队列。将患者数据与各自地区的癌症登记处进行了关联。通过观察到的和预期的病例数除以标准化发病比来估计随后发生癌症的风险。
在诊断为外阴硬化性苔藓的 3414 名女性中（对应 38210 人年的随访时间，平均随访 11.2 年），我们共发现 229 例癌症（不包括皮肤癌和诊断时存在的肿瘤）。我们发现外阴癌的风险增加（标准化发病比=17.4；95%可信区间 13.4-22.7）、阴道癌（标准化发病比=2.7；95%可信区间 0.32-9.771）和口咽癌（标准化发病比=2.5；95%可信区间 1.1-5.0），而其他妇科肿瘤（宫颈、子宫内膜、卵巢）和乳腺癌的风险降低。
外阴硬化性苔藓患者应每年进行妇科检查，仔细检查外阴和阴道。口咽癌风险增加也表明需要对患有外阴硬化性苔藓的患者进行口咽腔症状和病变的检查。
