Ndubisi B, Kaminski P F, Olt G, Sorosky J, Singapuri K, Hackett T, Hetzel D, Zaino R, Mortel R, Podczaski E
Department of Obstetrics and Gynecology, M.S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.
Gynecol Oncol. 1995 Oct;59(1):34-7. doi: 10.1006/gyno.1995.1264.
In order to determine the prognostic significance of applying the revised FIGO staging system and identify factors contributing to survival after documentation of recurrent disease, a retrospective chart review of our vulvar cancer population was performed. Over a 17-year interval 135 patients were uniformly treated with primary surgical treatment consisting of radical vulvectomy and bilateral groin dissection. Factors contributing to disease-free survival were analyzed using a Cox proportional hazards model. Covariates of survival after recurrence of disease were analyzed using the log-rank method. Neither the clinical assessment of the groin nodes, nor the presence or absence of perineal involvement were related to outcome. Only lesion size and surgical status of the inguinal nodes were significant predictors of disease-free survival (P = 0.02 and P = 0.03, respectively). In addition, there was a statistically significant relationship between the extent of groin involvement (negative, unilateral positive, and bilateral positive nodes) and associated decrement in disease-free survival (P = 0.01). Thirty patients developed recurrence of disease from 2.0 to 47.3 months following surgery. The location of the recurrence, interval from primary therapy to recurrence, and status of the groin nodes at initial surgery were significant prognostic factors in subsequent survival. The revised staging system demonstrated an improvement in patient stratification compared to the criteria of the prior classification. The data are also consistent with the distinction made between Stage III and IV disease in the new classification. The status of the groin nodes at original surgery remained an important prognostic factor even in those patients who later demonstrated recurrence of disease.
为了确定应用修订后的国际妇产科联盟（FIGO）分期系统的预后意义，并确定复发性疾病确诊后影响生存的因素，我们对外阴癌患者群体进行了回顾性病历审查。在17年的时间里，135例患者均接受了包括根治性外阴切除术和双侧腹股沟淋巴结清扫术在内的原发性手术治疗。使用Cox比例风险模型分析了无病生存的影响因素。采用对数秩检验法分析疾病复发后生存的协变量。腹股沟淋巴结的临床评估以及会阴是否受累均与预后无关。仅病变大小和腹股沟淋巴结的手术状态是无病生存的显著预测因素（分别为P = 0.02和P = 0.03）。此外，腹股沟受累程度（阴性、单侧阳性和双侧阳性淋巴结）与无病生存的相关降低之间存在统计学显著关系（P = 0.01）。30例患者在术后2.0至47.3个月出现疾病复发。复发部位、从初次治疗到复发的间隔时间以及初次手术时腹股沟淋巴结的状态是后续生存的重要预后因素。与先前分类标准相比，修订后的分期系统在患者分层方面有所改进。这些数据也与新分类中III期和IV期疾病的区分一致。即使在那些后来出现疾病复发的患者中，初次手术时腹股沟淋巴结的状态仍然是一个重要的预后因素。
