Ⅰ期外阴癌复发的影响因素分析

胡鹏?曾蓉?张慧峰

【摘要】目的 探讨Ⅰ期外阴癌复发的影响因素。方法 收集51例Ⅰ期外阴癌患者的病历资料，其中ⅠA期12例、ⅠB期39例。通过随访了解患者的复发及生存情况，根据手术治疗结束半年后是否出现临床、病理复发将患者分为未复发组和复发组，归纳2组患者的临床病理特征，应用Cox回归分析Ⅰ期外阴癌复发的影响因素。结果 51例Ⅰ期外阴癌患者中有20例复发，共3例死亡（1例ⅠA期，2例ⅠB期）。单因素Cox回归分析提示组织学分级、治疗方式、切缘、浸润深度是Ⅰ期外阴癌复发的相关因素（P均< 0.05），而绝经、肿瘤位置、病理类型、临床分期、肿瘤最大直径与其复发无关（P均> 0.05）。多因素Cox回归分析提示组织学分级为低分化、切缘阳性、浸润深度> 5 mm是Ⅰ期外阴癌复发的影响因素（P均< 0.05）。结论 Ⅰ期外阴癌患者手术治疗后，对于病理结果提示组织学分级为低分化、切缘阳性、浸润深度> 5 mm者，需密切随访，若有复发征象，应采取积极的干预措施。

【关键词】外阴癌;复发;组织学分级;切缘;浸润深度

Influencing factors of recurrence of patients with stageⅠ vulvar cancer Hu Peng， Zeng Rong， Zhang Huifeng. Department of Gynecological Oncology， Hubei Cancer Hospital， Wuhan 430070， China

Corresponding author， Zhang Huifeng， E-mail： zhf20081217@ 126. com

【Abstract】Objective To investigate the influencing factors of the recurrence of patients with grade I vulvar cancer. Methods Clinical data of 51 patients with stage Ⅰvulvar cancer were collected including 12 cases of stage ⅠA and 39 cases of stage ⅠB. According to the clinical or pathological recurrence at postoperative 6 months， all patients were divided into the non-recurrence and recurrence groups. Clinical characteristics and clinicopathological data were analysed in two groups. The influencing factors of the recurrence of stage Ⅰ vulvar cancer were further analyzed by Cox regression analysis. Results Among 51 cases， 20 patients recurred and 3 cases died （1 case of stage ⅠA and 2 cases of stage ⅠB）. Univariate Cox regression analysis demonstrated that histological classification， therapeutic method， incisional margin， depth of invasion were the influencing factors of the recurrence of stage Ⅰ vulvar cancer （all P < 0.05）. Nevertheless， menopause， tumor site， pathological type， clinical staging and maximal tumor diameter were not significantly correlated with the recurrence of vulvar cancer （all P > 0.05）. Multivariate Cox regression analysis prompted that low-grade differentiation， positive incisional margin and depth of invasion > 5 mm were the influencing factors of the recurrence of stage Ⅰ vulvar cancer （all P < 0.05）.  Conclusions Postoperatively， patients with low-grade differentiation， positive incisional margin and depth of invasion > 5 mm should be intimately followed up. Preventive measures should be actively taken if any recurrent signs occur.

【Key words】Vulvar cancer;Recurrence;Histological classification;Incisional margin;

Depth of invasion

外陰癌是妇科第四大恶性肿瘤，约占女性生殖道原发恶性肿瘤的4%，主要影响老年女性。根据FIGO 2009年外阴癌分期，Ⅰ期外阴癌是指肿瘤局限于外阴（和）或会阴、淋巴结无转移。外阴癌的文献报道较少，尤其是有关Ⅰ期患者复发影响因素的分析更少。本文收集湖北省肿瘤医院2010年1月至2017年1月51例Ⅰ期外阴癌患者的病历资料，并对复发相关因素进行分析，现报告如下。

对象与方法

一、研究对象

收集2010年1月至2017年1月在湖北省肿瘤医院住院并手术治疗的51例Ⅰ期外阴癌患者病历资料。51例患者中，ⅠA期12例、ⅠB期39例。病例纳入标准：经术后病理活组织检查（活检）证实为外阴癌，根据2009年FIGO分期诊断为Ⅰ期，且入院后为初次治疗，病历和随访资料完整。排除……