Farias-Eisner R, Cirisano F D, Grouse D, Leuchter R S, Karlan B Y, Lagasse L D, Berek J S
Department of Obstetrics and Gynecology, UCLA School of Medicine, Jonsson Comprehensive Cancer Center 90024.
Gynecol Oncol. 1994 Apr;53(1):55-8. doi: 10.1006/gyno.1994.1087.
We studied the outcome of patients undergoing radical local excision (modified radical vulvectomy) with inguinal-femoral lymphadenectomy through separate groin incisions for stage I and II invasive squamous carcinoma of the vulva. The purpose was to determine whether less radical and more individualized surgery is consistent with local control and cure. We have reported previously our experience using radical local excision and modified radical vulvectomy in stage I disease (Obstet. Gynecol. 63, 155 (1984)) and with separate groin incisions (Obstet. Gynecol. 58, 574 (1981)). This current report expands our experience with stage I and adds stage II patients treated over the past decade. Seventy-four patients were studied retrospectively over the 5-year period ending in January 1990. Reviews of both patient charts and histopathology reports were correlated with recurrence and survival. Factors analyzed included FIGO stage and grade, histology, lesion size and depth of invasion, surgical procedure, radiotherapy, lymph node status, interval to and site of recurrence, and survival. Thirty-nine patients had stage I disease and 35 had stage II. The primary operation was a radical local excision (modified radical vulvectomy) in 56 patients and radical vulvectomy in 18 patients; 13 underwent ipsilateral inguinal-femoral lymphadenectomy and 58 bilateral lymphadenectomy, each through separate groin incisions. The survival of those treated conservatively (97 and 90% for stages I and II, respectively) is the same as those undergoing a radical vulvectomy (100 and 75% for stages I and II, respectively) with only the presence of inguinal-femoral lymph node metastases impacting negatively on survival. In the entire group, the survival for negative and positive nodes was 98 and 45%, respectively. In conclusion, conservative, modified, and individualized vulvectomy in both stage I and II disease is associated with the same outcome and survival as radical vulvectomy, and lymph node status is the most important prognostic factor.
我们研究了采用根治性局部切除（改良根治性外阴切除术）并通过腹股沟分开切口行腹股沟-股淋巴结清扫术治疗Ⅰ期和Ⅱ期浸润性外阴鳞状细胞癌患者的治疗结果。目的是确定较不根治且更个体化的手术是否与局部控制及治愈相一致。我们之前已经报告过在Ⅰ期疾病中使用根治性局部切除和改良根治性外阴切除术的经验（《妇产科学》63卷，第155页（1984年））以及采用腹股沟分开切口的经验（《妇产科学》58卷，第574页（1981年））。本报告扩展了我们在Ⅰ期方面的经验，并纳入了过去十年中治疗的Ⅱ期患者。在截至1990年1月的5年期间，对74例患者进行了回顾性研究。对患者病历和组织病理学报告的审查与复发及生存情况相关联。分析的因素包括国际妇产科联盟（FIGO）分期和分级、组织学、病变大小及浸润深度、手术方式、放疗、淋巴结状态、复发间隔及部位以及生存情况。39例患者为Ⅰ期疾病，35例为Ⅱ期。56例患者的初次手术为根治性局部切除（改良根治性外阴切除术），18例为根治性外阴切除术；13例行同侧腹股沟-股淋巴结清扫术，58例行双侧淋巴结清扫术，均通过腹股沟分开切口进行。保守治疗患者的生存率（Ⅰ期和Ⅱ期分别为97%和90%）与接受根治性外阴切除术患者的生存率（Ⅰ期和Ⅱ期分别为100%和75%）相同，只有腹股沟-股淋巴结转移的存在对生存有负面影响。在整个研究组中，淋巴结阴性和阳性患者的生存率分别为98%和45%。总之，Ⅰ期和Ⅱ期疾病采用保守、改良及个体化外阴切除术与根治性外阴切除术的治疗结果及生存率相同，且淋巴结状态是最重要的预后因素。
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