Carli P, Cattaneo A, De Magnis A, Biggeri A, Taddei G, Giannotti B
II Dermatology Clinic, University of Florence, Italy.
Eur J Cancer Prev. 1995 Dec;4(6):491-5. doi: 10.1097/00008469-199512000-00008.
Histological changes of lichen sclerosus (LS)--a chronic inflammatory disease--are frequently found in association with squamous cell carcinoma (SCC) of the vulva, suggesting that women with this disorder are at increased risk. However, follow-up studies have been less convincing, showing that the vast majority of these patients do not go on to develop cancer. In this study, a series of 211 women affected by histologically demonstrated vulval LS were treated with topical therapy (testosterone, clobetasol) and followed prospectively by repetitive vulval examination. Three patients developed SCC of the vulva (two invasive, one in situ) at the sites affected by LS during an average follow-up period of 1 year and 8 months. Compared with the reference population, the number of cases of invasive SCC detected significantly exceeded the number estimated to occur in a comparable age-matched group. The standardized incidence rate of vulval SCC in the LS cohort was 317 (95% CI 35.7-1146.2). Cumulative risk was 14.8% (0.06% in the general female population), with a relative risk of 246.6. In conclusion, these data support the view that LS is a precursor of SCC, although characterized by slight tendency to evolve to carcinoma. Medical treatment of LS, although useful in the control of severity of disease, did not seem to be able to prevent the evolution to malignancy.
硬化性苔藓（LS）是一种慢性炎症性疾病，其组织学改变常与外阴鳞状细胞癌（SCC）相关，这表明患有这种疾病的女性患癌风险增加。然而，随访研究的说服力较弱，表明这些患者中的绝大多数并未发展为癌症。在本研究中，对211名经组织学证实患有外阴LS的女性进行了局部治疗（睾酮、氯倍他索），并通过重复的外阴检查进行前瞻性随访。在平均1年8个月的随访期内，3名患者在LS受累部位发生了外阴SCC（2例浸润性，1例原位）。与参考人群相比，检测到的浸润性SCC病例数显著超过了在年龄匹配的可比组中估计发生的病例数。LS队列中外阴SCC标准化发病率为317（95%CI 35.7-1146.2）。累积风险为14.8%（一般女性人群中为0.06%），相对风险为246.6。总之，这些数据支持LS是SCC的前驱病变这一观点，尽管其演变为癌的倾向较小。LS的药物治疗虽然有助于控制疾病严重程度，但似乎无法预防其恶变。
