摘要
To compare patterns of recurrence and disease-free survival (DFS) of node-po sitive and node-negative patients with advanced vulval squamous cell carcinoma (SCC). Fifty-five patients with FIGO stage III/IVA vulval SCC who had surgery a t the Queensland Centre for Gynaecological Cancer from 1989 to 1999 were include d. Patients were grouped as follows: Group A, pT3 N0; Group B, pT3 N1; Group C, pT4 N2. Treatment included surgery ±.postoperative radiotherapy. Multivariate C ox models were calculated to identify independent prognostic factors. After a me dian follow-up of 96 months, 25 patients (45.5%) experienced recurrence at the vulva (n = 2), pelvis (n = 8), or distant sites (n = 15)-. Recurrence in the p elvis and at distant sites was more likely for patients in groups B and C (P 0.0 03). At 5 years the probability of DFS was 66.6%, 35.3%, and 39.8%for patient s in groups A, B, and C, respectively (P 0.085)-. Patients with negative nodes (n = 15), one microscopic positive node (n = 11), and two or more positive nodes (n = 29) had a probability of DFS of 66.6%, 67.3%, and 26.1%at 5 years, resp ectively (P 0.005). Patients with ≥2 positive groin nodes are at risk for dista nt failure. The DFS of patients with negative groin nodes and those with only on e microscopic positive node is very similar. The prognosis of patients with ≥2 positive unilateral or bilateral groin nodes is similar. The current FIGO stagin g system inaccurately reflects prognosis for patients with advanced vulval cance r. Clinical trials are warranted to investigate the benefit of systemic treatmen t.
To compare patterns of recurrence and disease-free survival (DFS) of node-po sitive and node-negative patients with advanced vulval squamous cell carcinoma (SCC). Fifty-five patients with FIGO stage III/IVA vulval SCC who had surgery a t the Queensland Centre for Gynaecological Cancer from 1989 to 1999 were include d. Patients were grouped as follows: Group A, pT3 N0; Group B, pT3 N1; Group C, pT4 N2. Treatment included surgery ±.postoperative radiotherapy. Multivariate C ox models were calculated to identify independent prognostic factors. After a me dian follow-up of 96 months, 25 patients (45.5%) experienced recurrence at the vulva (n = 2), pelvis (n = 8), or distant sites (n = 15)-. Recurrence in the p elvis and at distant sites was more likely for patients in groups B and C (P 0.0 03). At 5 years the probability of DFS was 66.6%, 35.3%, and 39.8%for patient s in groups A, B, and C, respectively (P 0.085)-. Patients with negative nodes (n = 15), one microscopic positive node (n = 11), and two or more positive nodes (n = 29) had a probability of DFS of 66.6%, 67.3%, and 26.1%at 5 years, resp ectively (P 0.005). Patients with ≥2 positive groin nodes are at risk for dista nt failure. The DFS of patients with negative groin nodes and those with only on e microscopic positive node is very similar. The prognosis of patients with ≥2 positive unilateral or bilateral groin nodes is similar. The current FIGO stagin g system inaccurately reflects prognosis for patients with advanced vulval cance r. Clinical trials are warranted to investigate the benefit of systemic treatmen t.
