外阴恶性黑色素瘤。75例患者预后因素评估，重点关注DNA倍体。

Malignant melanoma of the vulva. Evaluation of prognostic factors with emphasis on DNA ploidy in 75 patients.

作者信息

Scheistrøen M, Tropé C, Koern J, Pettersen E O, Abeler V M, Kristensen G B

机构信息

Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo.

出版信息

Cancer. 1995 Jan 1;75(1):72-80. doi: 10.1002/1097-0142(19950101)75:1<72::aid-cncr2820750113>3.0.co;2-g.

DOI:10.1002/1097-0142(19950101)75:1<72::aid-cncr2820750113>3.0.co;2-g

PMID:7804980

Abstract

BACKGROUND

To the authors' knowledge, the potential prognostic value of DNA ploidy in vulvar melanoma has not been evaluated in previous series.

METHODS

Clinical data and follow-up information were retrieved from the hospital records of 75 patients treated from 1956 to 1987. Histopathologic specimens were reviewed for histologic type, depth of invasion, vessel invasion, and ulceration. Flow cytometric DNA measurements were performed on paraffin embedded samples.

RESULTS

Forty-three patients had International Federation of Gynecology and Obstetrics Stage I disease, 14 Stage II, 8 Stage III and 10 Stage IV. Sixty-five patients were treated by surgery, six by radiotherapy, and four patients with advanced disease received no therapy. The surgical procedure was local excision in 17 patients, vulvectomy in 22, and radical vulvectomy with inguinal lymph node dissection in 26. Five- and 10-year corrected survival rates were 46% and 37%, respectively. Recurrences were seen in 43 (66%) of the patients treated by surgery. Independent prognostic factors for corrected survival in the entire group of 75 patients were inguinal lymph node metastases (P = 0.016), angioinvasion (P = 0.027), tumor localization to clitoris, and multifocal tumors (P = 0.043). For the 65 patients treated by surgery, independent prognostic factors for disease free survival were angioinvasion (P < 0.001), age at diagnosis (P = 0.003), DNA ploidy (P = 0.004), and ulceration (P = 0.027). The independent prognostic factors for long term survival were tumor localization to clitoris (P = 0.018), DNA ploidy (P = 0.045), and inguinal lymph node involvement (P = 0.053). Radical surgery did not improve disease free or long term survival.

CONCLUSIONS

DNA ploidy is an independent factor that predicts prognosis in patients with vulvar melanoma, and should be considered together with previously known factors. Radical surgery does not improve prognosis and is not recommended when the inguinal lymph nodes are clinically negative.

摘要

背景

据作者所知，此前的系列研究尚未评估DNA倍性在外阴黑色素瘤中的潜在预后价值。

方法

从1956年至1987年接受治疗的75例患者的医院记录中检索临床数据和随访信息。对组织病理学标本进行组织学类型、浸润深度、血管浸润和溃疡情况的复查。对石蜡包埋样本进行流式细胞术DNA测量。

结果

43例患者为国际妇产科联盟（FIGO）I期疾病，14例为II期，8例为III期，10例为IV期。65例患者接受手术治疗，6例接受放疗，4例晚期疾病患者未接受治疗。手术方式为17例行局部切除，22例行外阴切除，26例行根治性外阴切除加腹股沟淋巴结清扫。5年和10年校正生存率分别为46%和37%。接受手术治疗的患者中有43例（66%）出现复发。在整个75例患者组中，校正生存的独立预后因素为腹股沟淋巴结转移（P = 0.016）、血管浸润（P = 0.027）、肿瘤位于阴蒂以及多灶性肿瘤（P = 0.043）。对于65例接受手术治疗的患者，无病生存的独立预后因素为血管浸润（P < 0.001）、诊断时年龄（P = 0.003）、DNA倍性（P = 0.004）和溃疡（P = 0.027）。长期生存的独立预后因素为肿瘤位于阴蒂（P = 0.018）、DNA倍性（P = 0.045）和腹股沟淋巴结受累（P = 0.053）。根治性手术并未改善无病生存或长期生存。