Visco A G, Del Priore G
Division of Gynecologic Oncology, New York University Medical School, New York, USA.
Obstet Gynecol. 1996 Feb;87(2):286-90. doi: 10.1016/0029-7844(95)00404-1.
To assess the risk of Bartholin gland carcinoma in postmenopausal women.
A referral patient population from a tertiary care cancer center and a hospital-based regional tumor registry was used in a case-control and retrospective cohort study. We searched for data on any discharge diagnosis or procedures involving the Bartholin gland, including excision, cystectomy, or marsupialization, and pathology reports confirming cancer diagnoses from a hospital-based regional tumor registry and a tertiary hospital's medical records department and operating room log.
A total of 284 patients were identified, 161 patients from the hospital-based tumor registry and 123 from the tertiary hospital data bases. Pathology reports from 104 of the 161 patients with vulvar cancer were available and revealed two primary adenocarcinomas in postmenopausal women, one squamous cell carcinoma of the Bartholin gland in a postmenopausal woman, and two squamous cell carcinomas of the Bartholin gland in premenopausal patients over a 24-year period. Based on local New York State Department of Health census data, the incidence of Bartholin gland carcinoma was 0.023 per 100,000 woman-years in premenopausal women and 0.114 per 100,000 woman-years in postmenopausal women (incidence rate ratio 5.01, 95% confidence interval [CI] 0.67-25.1). The overall incidence rate of squamous cell vulvar carcinoma was 0.42 per 100,000 woman-years in premenopausal and 4.72 per 100,000 woman-years in postmenopausal women (odds ratio [OR] 11.55, 95% CI 7.82-17.14). The ratio of Bartholin gland cancer to other vulvar cancers was two per 37 in premenopausal women versus three per 124 in postmenopausal women (OR 2.3, 95% CI 0.39-17.9). Of thirteen postmenopausal patients (mean age 65.4 years) with Bartholin gland enlargement admitted to the tertiary care center, only four (30.8%) had excisions, whereas the remainder (69.2%) had drainage or marsupialization. None of the patients treated with drainage or marsupialization were listed subsequently in the tumor registry as developing Bartholin gland cancer during a median surveillance of 10.3 years (range 1.7-14.4).
Bartholin gland cancer is exceedingly rare in all women, including postmenopausal women. We were unable to find evidence that would justify excision as the initial treatment of a Bartholin gland enlargement in postmenopausal women. Drainage and selective biopsy may be sufficient as initial management.
评估绝经后女性患巴氏腺癌的风险。
在一项病例对照和回顾性队列研究中，使用了来自三级医疗癌症中心和基于医院的区域肿瘤登记处的转诊患者群体。我们搜索了有关巴氏腺的任何出院诊断或手术的数据，包括切除术、囊肿切除术或袋形缝合术，以及来自基于医院的区域肿瘤登记处、三级医院病历部门和手术室日志的确诊癌症的病理报告。
共识别出284例患者，其中161例来自基于医院的肿瘤登记处，123例来自三级医院数据库。161例外阴癌患者中有104例的病理报告可供使用，结果显示在24年期间，绝经后女性中有2例原发性腺癌，1例绝经后女性巴氏腺鳞状细胞癌，以及2例绝经前患者巴氏腺鳞状细胞癌。根据纽约州当地卫生部的人口普查数据，绝经前女性巴氏腺癌的发病率为每100,000妇女年0.023例，绝经后女性为每100,000妇女年0.114例（发病率比5.01，95%置信区间[CI]0.67 - 25.1）。绝经前女性外阴鳞状细胞癌的总体发病率为每100,000妇女年0.42例，绝经后女性为每100,000妇女年4.72例（优势比[OR]11.55，95%CI 7.82 - 17.14）。绝经前女性巴氏腺癌与其他外阴癌的比例为每37例中有2例，绝经后女性为每124例中有3例（OR 2.3，95%CI 0.39 - 17.9）。在三级医疗中心收治的13例绝经后巴氏腺肿大患者（平均年龄65.4岁）中，只有4例（30.8%）接受了切除术，其余（69.2%）接受了引流或袋形缝合术。在中位随访10.3年（范围1.7 - 14.4年）期间，接受引流或袋形缝合术治疗的患者中，没有一人随后在肿瘤登记处被列为患巴氏腺癌。
巴氏腺癌在所有女性中都极为罕见，包括绝经后女性。我们未能找到证据证明将切除术作为绝经后女性巴氏腺肿大的初始治疗方法是合理的。引流和选择性活检作为初始治疗可能就足够了。
