Phillips G L, Bundy B N, Okagaki T, Kucera P R, Stehman F B
Department of Obstetrics and Gynecology, Louisiana State University Medical Center, Shreveport.
Cancer. 1994 May 15;73(10):2626-32. doi: 10.1002/1097-0142(19940515)73:10<2626::aid-cncr2820731026>3.0.co;2-u.
Beginning in 1983, the Gynecologic Oncology Group (GOG) conducted a prospective clinicopathologic study of primary malignant melanoma of the vulva. The objectives of this study were to determine the relationship of histopathologic parameters and microstaging to the International Federation of Gynaecology and Obstetrics (FIGO) staging and prognosis.
All patients with primary untreated malignant melanoma of the vulva and no history of previous or subsequent other primary invasive malignancy were eligible for study entry. All patients were required to have modified radical hemivulvectomy as minimal therapy. Groin dissection was optional. Histopathologic specimens were reviewed for capillary space involvement, Clark's level, Breslow's depth of invasion, cell type, and melanin distribution. Patient characteristics were analyzed in their relationship to groin node status and recurrence-free interval.
Between 1983 and 1990, 81 patients were entered in the study. Of these, 71 were evaluable. Thirty-four patients underwent radical hemivulvectomy, and 37 patients underwent radical vulvectomy. In addition, 56 patients underwent groin node dissection. The factors that were independently correlated with groin node status were: capillary lymphatic space involvement (p = 0.0001) and central primary tumor location (i.e., bilateral/clitoral/T3) (P = 0.003). The other factors that were significant--clinical tumor size, vulvar staging (FIGO), GOG performance status, and Breslow's depth of invasion--were not independent predictors of positive nodes. The factor with the highest significant correlation with recurrence-free interval was the 1992 staging system of the American Joint Committee on Cancer (AJCC) for malignant melanoma of the skin. Using multiple regression, AJCC stage was the only independent prognostic factor. In the absence of AJCC stage, Breslow's depth of invasion was the most prognostic.
The biologic behavior of vulvar melanoma is similar to other nongenital cutaneous malignant melanoma.
从1983年开始，妇科肿瘤学组（GOG）对外阴原发性恶性黑色素瘤进行了一项前瞻性临床病理研究。本研究的目的是确定组织病理学参数和微分期与国际妇产科联盟（FIGO）分期及预后的关系。
所有原发性未经治疗的外阴恶性黑色素瘤患者，且无既往或后续其他原发性浸润性恶性肿瘤病史者均符合研究入组条件。所有患者均需接受改良根治性半外阴切除术作为最低限度治疗。腹股沟淋巴结清扫术为选择性手术。对组织病理学标本进行检查，以确定是否有毛细血管间隙受累、克拉克分级、布雷斯洛浸润深度、细胞类型和黑色素分布情况。分析患者特征与腹股沟淋巴结状态及无复发生存期的关系。
1983年至1990年期间，81例患者进入本研究。其中，71例可进行评估。34例患者接受了根治性半外阴切除术，37例患者接受了根治性外阴切除术。此外，56例患者接受了腹股沟淋巴结清扫术。与腹股沟淋巴结状态独立相关的因素为：毛细血管淋巴管间隙受累（p = 0.0001）和原发性肿瘤位于中央（即双侧/阴蒂/T3）（P = 0.003）。其他有意义的因素——临床肿瘤大小、外阴分期（FIGO）、GOG体能状态和布雷斯洛浸润深度——并非阳性淋巴结的独立预测因素。与无复发生存期相关性最高的因素是美国癌症联合委员会（AJCC）1992年皮肤恶性黑色素瘤分期系统。采用多元回归分析，AJCC分期是唯一的独立预后因素。在没有AJCC分期的情况下，布雷斯洛浸润深度的预后价值最大。
外阴黑色素瘤的生物学行为与其他非生殖器皮肤恶性黑色素瘤相似。
