Lenz Caroline, Lyu Su Ir, Mallmann Peter, Morgenstern Bernd, Thangarajah Fabinshy
Department of Gynecology and Gynecologic Oncology, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, 50931 Cologne, Germany.
Department of Pathology, University Hospital of Cologne, 50931 Cologne, Germany.
J Clin Med. 2025 Jun 8;14(12):4057. doi: 10.3390/jcm14124057.
Vulvar carcinoma is a rare malignancy with approximately 3090 cases annually in Germany. Squamous cell carcinoma of the vulva (SCC) can be HPV-associated or non-HPV-associated. Surgical excision is the primary treatment, but the optimal tumor-free resection margin remains debated. This study evaluates the impact of resection margin distance on disease prognosis in SCC patients. A retrospective analysis was conducted on patients diagnosed with SCC of the vulva at the University Hospital of Cologne between 2007 and 2022. Patients with TNM stage pT1a or higher who underwent primary surgical treatment with a tumor-free resection margin status were included. The cohort of 73 patients was divided into three groups based on resection margin distance: >0.01-<0.3 cm (Group 1), ≥0.3-<0.8 cm (Group 2), and ≥0.8 cm (Group 3). Statistical analyses including logrank tests were performed to assess correlations between resection margin distance and recurrence, disease-free survival (DFS), and overall survival (OS). A total of 37.0% of patients were categorized into Group 1, 48.0% into Group 2, and 15.1% into Group 3. Disease recurrence occurred in 26% of patients, with rates of 31.6% in Group 1 (minimum resection margin distance), 42.1% in Group 2, and 26.3% in Group 3. The prevalence of recurrence was not dependent on resection margin distance ( = 0.28). Similarly, the prevalence of deaths was not dependent on resection margin distance ( = 0.43). Disease-free survival (DFS) and overall survival (OS) did not show significant differences between the groups ( = 0.25 and = 0.87, respectively). This study found no significant impact of pathological tumor-free resection margin distance on DFS or OS in patients with SCC of the vulva. Given the heterogeneity in international guidelines and existing literature, further studies with larger patient cohorts are needed to establish definitive surgical recommendations.
外阴癌是一种罕见的恶性肿瘤，在德国每年约有3090例病例。外阴鳞状细胞癌（SCC）可分为人乳头瘤病毒（HPV）相关型和非HPV相关型。手术切除是主要治疗方法，但最佳的无瘤切缘仍存在争议。本研究评估切缘距离对外阴SCC患者疾病预后的影响。对2007年至2022年期间在科隆大学医院被诊断为外阴SCC的患者进行了回顾性分析。纳入接受了无瘤切缘状态的初次手术治疗且TNM分期为pT1a或更高的患者。73例患者的队列根据切缘距离分为三组：>0.01 - <0.3厘米（第1组）、≥0.3 - <0.8厘米（第2组）和≥0.8厘米（第3组）。进行了包括对数秩检验在内的统计分析，以评估切缘距离与复发、无病生存期（DFS）和总生存期（OS）之间的相关性。共有37.0%的患者被归入第1组，48.0%归入第2组，15.1%归入第3组。26%的患者发生疾病复发，第1组（最小切缘距离）的复发率为31.6%，第2组为42.1%，第3组为26.3%。复发率不依赖于切缘距离（P = 0.28）。同样，死亡率也不依赖于切缘距离（P = 0.43）。各组之间无病生存期（DFS）和总生存期（OS）没有显著差异（分别为P = 0.25和P = 0.87）。本研究发现，病理无瘤切缘距离对外阴SCC患者的DFS或OS没有显著影响。鉴于国际指南和现有文献存在异质性，需要进一步开展更大患者队列的研究以制定明确的手术建议。
