Piura B, Masotina A, Murdoch J, Lopes A, Morgan P, Monaghan J
Regional Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, England, United Kingdom.
Gynecol Oncol. 1993 Feb;48(2):189-95. doi: 10.1006/gyno.1993.1032.
In a study of 73 patients, diagnosed with recurrent squamous cell carcinoma of the vulva between 1975 and 1990, the effect of clinical variables on the outcome was evaluated. The overall 5-year survival rate was 35.2%. Of the 73 patients, 33 (45.2%) originally had Stage I or II disease and 40 (54.8%) Stage III or IVA; 49 (67.1%) recurred less than 2 years and 24 (32.9%) more than 2 years after initial surgery; and 39 (53.4%) recurred on the vulva only, while 34 (46.6%) recurred beyond the vulva. Of 59 patients who had groin lymph node dissection at initial surgery, 26 (44%) had negative and 33 (56%) had positive nodes. By means of univariate analyses, a significant worsening in outcome was demonstrated with advancing original stage of disease (P < 0.001), positivity of groin lymph nodes (P < 0.01), shortening of recurrence-free interval (P < 0.001), and extension of recurrence beyond the vulva (P < 0.001). In a multivariate analysis (Cox proportional hazards model) recurrence site was the strongest and the only significant predictor of survival. The death risk showed a 3.7-fold increase (95% confidence intervals: 1.6 to 8.7, P = 0.002) for recurrence beyond the vulva over recurrence on the vulva only. For patients who recurred in the vulva only, wide radical local excision provided acceptable survival results, while for all other patients, regardless of type of treatment, the outcome was poor.
在一项针对73例于1975年至1990年间被诊断为复发性外阴鳞状细胞癌患者的研究中，评估了临床变量对预后的影响。总体5年生存率为35.2%。在这73例患者中，33例（45.2%）最初为I期或II期疾病，40例（54.8%）为III期或IVA期；49例（67.1%）在初次手术后不到2年复发，24例（32.9%）在初次手术后超过2年复发；39例（53.4%）仅在外阴复发，而34例（46.6%）在外阴以外部位复发。在初次手术时进行腹股沟淋巴结清扫的59例患者中，26例（44%）淋巴结阴性，33例（56%）淋巴结阳性。通过单因素分析，结果显示随着疾病原发分期的进展（P < 0.001）、腹股沟淋巴结阳性（P < 0.01）、无复发生存期缩短（P < 0.001）以及复发超出外阴范围（P < 0.001），预后显著恶化。在多因素分析（Cox比例风险模型）中，复发部位是生存的最强且唯一显著预测因素。外阴以外部位复发的死亡风险比仅在外阴复发的死亡风险高3.7倍（95%置信区间：1.6至8.7，P = 0.002）。对于仅在外阴复发的患者，广泛根治性局部切除可提供可接受的生存结果，而对于所有其他患者，无论治疗类型如何，预后均较差。
