Crum C P, Liskow A, Petras P, Keng W C, Frick H C
Cancer. 1984 Oct 1;54(7):1429-34. doi: 10.1002/1097-0142(19841001)54:7<1429::aid-cncr2820540733>3.0.co;2-g.
Forty-one cases of vulvar intraepithelial neoplasia (VIN) were analyzed clinicopathologically with emphasis on the changes in age-specific incidence rates, coexisting condylomata, coexisting koilocytotic atypia, subsequent invasive carcinoma and response to therapy. The number of cases referred to in the interval from 1975 to 1982 was 26 compared with 15 in the interval from 1966 to 1974. In addition, the percentage of patients in each group younger than 45 years of age was 66% after 1975 versus 33% prior to 1975. The yearly incidence of patients older than 45 years of age remained constant. The association of condyloma or marked koilocytosis in the neoplastic epithelium per se correlated with a younger mean age (31.1 and 31.8 years, respectively) than the absence of condyloma or marked koilocytosis (45.5 years and 47.5 years, respectively). Carcinoma developed in five patients (10.2%), and the mean age of the group was 55 years. Four of the five developed carcinoma within 3 years of diagnosis of the VIN. The incidence of persistence of the VIN lesion or recurrence following local excision was 22% over a mean following of 6.1 years. Spontaneous regressions were not reported in this patient population. Vulvar intraepithelial neoplasia appears to be a disease of multiple etiology which affects at least two populations. The younger patients are associated with papilloma-virus infection, and have a low risk of progression to cancer. The older patients have a variable history of condylomata, and a higher risk of developing invasive cancers of the anogenital region. The most important risk factor from the clinicopathologic standpoint appears to be age.
对41例外阴上皮内瘤变（VIN）进行了临床病理分析，重点关注年龄特异性发病率的变化、并存的尖锐湿疣、并存的挖空细胞异型性、后续浸润癌以及对治疗的反应。1975年至1982年期间转诊的病例数为26例，而1966年至1974年期间为15例。此外，1975年后每组中年龄小于45岁的患者百分比为66%，而1975年前为33%。45岁以上患者的年发病率保持不变。肿瘤上皮本身存在尖锐湿疣或显著挖空细胞与平均年龄较年轻（分别为31.1岁和31.8岁）相关，而不存在尖锐湿疣或显著挖空细胞的患者平均年龄分别为45.5岁和47.5岁。5例患者发生了癌（10.2%），该组患者的平均年龄为55岁。5例中有4例在VIN诊断后3年内发生了癌。VIN病变持续存在或局部切除后复发的发生率在平均随访6.1年期间为22%。该患者群体中未报告自发消退情况。外阴上皮内瘤变似乎是一种多病因疾病，至少影响两个人群。年轻患者与乳头瘤病毒感染有关，进展为癌症的风险较低。老年患者有尖锐湿疣病史不一，发生肛门生殖器区域浸润癌的风险较高。从临床病理角度来看，最重要的危险因素似乎是年龄。
