40岁以下妇女卵巢上皮性癌的临床及病理学特点

目的：了解年龄小于４０岁妇女卵巢上皮性癌在临床及病理学方面的特点。方法：１９７８年１月至１９９２年１２月在我院诊治的年龄小于４０岁卵巢上皮性癌患者共５４例，选择与每一例同期手术、年龄大于４０岁卵巢上皮性癌５４例作为对照组，用ＳＰＳＳ及ＳＵＲＶＡＬ分析软件对两组临床及病理学资料进行对照分析。结果：年龄小于４０岁患者中，因偶然发现盆腹腔包块就诊者（４６．３％）多于对照组（２７．８％），而因出现症状就诊者（５３．７％）少于对照组（７２．２％），其早期诊断率（６１．１％）、肿瘤单侧发生率（６８．５％）、肿瘤最大径线均值（１３．６ｃｍ）、肿瘤分化程度（高分化占５０．０％）以及达到理想肿瘤细胞减灭术者均高于对照组。两组组织学类型及化疗情况相似。单因素分析，年龄小于４０岁患者预后好，其２年及５年生存率分别为６９．８％和５０．２％，８例保留健侧卵巢者均无复发。多因素分析显示年龄对预后无影响。结论：年龄小于４０岁患者的卵巢上皮性癌其分期较早，恶性程度较低，预后较好，部分患者手术时可保留卵巢功能。     

卵巢上皮性癌155例的治疗与预后

目的：探讨卵巢上皮性癌的治疗与影响预后的因素。方法：对１９７０年１月至１９９２年１２月在我院治疗的１５５例卵巢上皮性癌进行回顾性分析。全部手术切除标本经病理检查诊断并按ＦＩＧＯ分期标准进行分期，４２例行２次手术，４例行３次手术。除６例外，余１４９例均于手术后行化疗，３２例于第２次术后再次行化疗，９例因复发再次化疗。结果：２年、５年、１０年的生存率分别为Ⅰ期９２．４％、８７．０％、７０．６％；Ⅱ期９１．９％、６３．６％、４７．８％；Ⅲ期５９．９％、３８．２％、１９．２％；Ⅳ期２５．０％、２５．０％、０．０％（Ｐ＜０．００１）。６例未化疗者均在术后２年内死亡。结果表明，预后与临床分期、细胞分化、残留癌灶大小有关。５年生存率中，Ⅰ期为８７．０％和Ⅲ期为３８．２％（Ｐ＜０．００１）；Ｇ１的５年生存率为９５．９％，Ｇ３为１１．８％（Ｐ＜０．００１）；无残留癌灶者为９７．６％，残留癌灶＞２ｃｍ者为２１．２％（Ｐ＜０．００１）。结论：在卵巢上皮性癌初次手术时残留癌灶＜２ｃｍ，并于术后尽早开始化疗，可提高生存率。     

Ⅳ期卵巢上皮性癌肿瘤细胞减灭术及预后因素的临床研究

目的 探讨Ⅳ期卵巢上皮性癌的肿瘤细胞减灭术的意义和预后因素。方法 回顾性分析我院１９８６年１月至１９９７年１２月,经手术病理分期的Ⅳ期卵巢上皮性癌７１例,其中切净组（残留灶≤１ｃｍ）３０例,未切净组（残留灶〉１ｃｍ）４１例。结果 手术切净率为４２．３％。Ⅳ期卵巢上皮性癌各转移部位中,锁骨上淋巴结转移和胸膜转移患者切净组的预后明显好于未切净组（Ｐ〈０．０５）。Ⅳ期卵巢上皮性癌的总５年生态２率为６．１     

癌周注入微粒活性炭吸附抗癌剂用于外阴癌淋巴结清除术

在外阴癌根治术（ＶＣＲＳ）前于癌周注入微粒活性炭吸附抗癌剂（ＡＣＩＭＡＣＳＡＣＡ）行淋巴结染色（ＬＮＳ），术中将黑染的淋巴结作为手术均除的标记，效果满意。现报告如下。１资料与方法１．１临床资料１９９４至１９９８年我院收治外阴癌１８例，按ＦＩＧＯ标准分...     

子宫颈癌卵巢转移17例分析

目的：分析宫颈癌特别是早期宫颈癌卵巢转移的危险性。方法：回顾性分析１９５８年至１９９４年我院收治的１７例宫颈癌卵巢转移的情况。结果：１７例患者中，１０例为肉眼可见转移，７例为病理检查证实。１１例（５８．８％）转移至双侧卵巢，１３例同时累及宫体、盆腔及主动脉旁淋巴结。１７例患者中，１０例为宫颈鳞癌卵巢转移，７例为宫颈腺癌卵巢转移，转移率分别为０．０７％和１．８１％，差异有显著性（Ｐ＜０．０５）。１７例患者中，宫颈癌Ⅰ、Ⅱ期者为８例，宫颈鳞癌无Ⅰ期患者，Ⅱ期卵巢转移率为０．０８％；宫颈腺癌Ⅰ期卵巢转移率为９．５％，Ⅱ期为１．２％。手术治疗的Ⅰ、Ⅱ期患者中，宫颈腺癌的卵巢转移率为７．８％，Ⅱ期宫颈鳞癌患者的卵巢转移率为１．６％。１７例患者的预后差，５年生存率为１７．６％。结论：宫颈腺癌早期有发生卵巢转移的危险性。宫颈癌患者是否保留卵巢的问题，值得进一步探讨。     

子宫内膜癌DNA含量及细胞周期时相的研究

目的：探讨ＤＮＡ含量及细胞周期时相在判断子宫内膜癌预后中的价值。方法：采用流式细胞术对１００例子宫内膜癌的石蜡包埋组织，进行ＤＮＡ含量及细胞周期时相的测定。结果：子宫内膜癌的ＤＮＡ异倍体率为７１．０％。低分化、深肌层浸润及Ⅲ、Ⅳ期的患者，其ＤＮＡ异倍体率均分别高于高分化、无肌层浸润及Ⅰ期患者（Ｐ均＜０．０５）。Ｓ期细胞比率（ＳＰＦ）在低分化（Ⅲ级）、深肌层浸润及Ⅲ、Ⅳ期癌组织中含量也分别高于Ⅰ级、肌层浸润＜１／２及Ⅰ期患者的含量（Ｐ＜０．０１，＜０．０５）。ＤＮＡ异倍体患者的５年生存率为６５．９％，显著低于二倍体患者的８７．６％（Ｐ＜０．０１）。子宫内膜癌死亡患者的ＳＰＦ平均值为１７％。ＳＰＦ＞１７％者的５年生存率为５０．４％，显著低于ＳＰＦ＜１７％者的７９．１％（Ｐ＜０．０１）。ＳＰＦ及分期与预后的关系最为密切。结论：ＤＮＡ异倍体及高的ＳＰＦ值与子宫内膜癌的恶性生物学行为有关，ＤＮＡ倍体及ＳＰＦ是判断预后的重要指标。     

外阴转移性肿瘤78例临床报告

目的 了解外阴转移性肿瘤的临床特点,探讨其诊断及治疗方法,方法 回顾性分析１９５８～１９９５年收治的７８例外阴转移性肿瘤患者,其中宫颈癌转移６１例（７８．２％）尿癌转移５例,阴道癌转移４例子宫内膜癌转移３例,乳腺癌转移２例,卵巢癌,直肠癌,恶性淋巴转移各１例,结果 患者中位年龄５５岁,７５．６％（５９／７８）转移瘤在原发肿瘤诊断之后的１５天至１８年发现,中位间隔时间为２．５年,６１．５％（４８／７     

卵巢上皮性癌复发的处理

目的 探讨影响卵巢上皮性癌复发的因素及处理方法。方法 对１８９例卵巢癌进行回顾性分析,全部手术切除标本均经病理检查证实。结果 １８９例中,复发３１例。其中１９例为我院施行肿瘤细胞减灭术,残留癌灶直径≤２ｃｍ;１２例为外院施行肿瘤细胞减灭术,达到临床愈后因复发转入我院。复发的３１例初次手术中,Ⅰ、Ⅱ期４例（１２．９％）,Ⅲ、Ⅳ期２７例（８７．１％）。其中１０例手术切净者,平均复发时间为１７．２个月;     

晚期卵巢上皮性癌的预后变化及影响因素分析

目的：了解近２０余年晚期卵巢上皮性癌的预后有无改善，及影响预后的因素。方法：对１９７０年至１９９３年在我院住院治疗的１４０例晚期卵巢上皮性癌病例进行分析，按患者的初治时间分为两组，１９８０年１月以前的５６例为第１组，之后的８４例为第２组，计算两组的Ｋａｐｌａｎ－Ｍｅｉｅｒ生存率曲线，用ＳＰＳＳ及ＳＵＲＶＣＡＬＣ统计软件对资料进行单因素及ＣＯＸ逐步回归分析，确定影响患者预后的因素。结果：两组的病理资料无差异，但第２组得到了更积极的化疗。总的１年、２年及５年生存率分别为６１．２％、３２．１％和８．５％，第１组分别为４２．３％、２９．６％和４．５％，第２组分别为６９．３％、３６．２％和１１．２％，第２组预后好于第１组（Ｐ＜０．０５）。临床分期晚、分化差、残余瘤直径＞２ｃｍ者预后差。联合化疗≥４个疗程者预后改善，≥６个疗程者又较≥４个疗程者预后好。结论：晚期卵巢上皮性癌的预后近１０余年来有所改善，提高肿瘤细胞减灭术的彻底性及行至少６个疗程的联合化疗是改善预后的重要措施。     

卵巢交界性肿瘤的临床特征及治疗

目的明确卵巢交界性肿瘤（交界性瘤）的临床特征及治疗方法。方法对３５年来收治的７０例卵巢交界性瘤患者进行回顾性分析。结果患者年龄１６～７６岁,平均４５．６岁。组织类型粘液性４６例（６５．７％）,浆液性２１例（３０％）;临床分期Ⅰ期４６例（６５．７％）,Ⅱ期１例（１．４％）,Ⅲ期１１例（１５．７％）,无Ⅳ期患者。治疗后复发１２例（１７．１％）。ＣＡ１２５升高１１例（１１／２１）,癌胚抗原（ＣＥＡ）升高６例（６／１０）。治疗以手术为主,４５例术后接受辅助治疗。７０例中无瘤存活４５例,带瘤存活４例,死于交界性瘤１１例,死于其他原因１０例。１１例行单侧附件切除的Ⅰ期患者均无瘤存活。１６例术后有肿瘤残留并接受辅助治疗者中完全缓解２例。全组５年、１０年、２０年、３０年存活率分别为９０．０％、８７．１％、８７．１％和８５．６％。多因素分析显示,组织学类型、期别和术后肿瘤残留,是影响预后的主要因素。结论粘液性瘤所占比例明显高于浆液性瘤;手术治疗是交界性瘤有效的治疗手段,应力求将肿瘤完全切除;术后辅助治疗不能改善交界性瘤患者的预后;ＣＡ１２５和ＣＥＡ对于交界性瘤监测有一定意义     

外阴恶性肿瘤79例临床治疗方法及预后分析

目的:探讨外阴恶性肿瘤不同治疗方法的临床效果及预后。方法:对2000年1月至2010年6月本院收治的79例外阴恶性肿瘤的治疗及预后进行回顾性研究。结果:Ⅰ、Ⅱ、Ⅲ、Ⅳ期的3年、5年生存率比较差异均有统计学意义(P<0.05);部分性外阴根治术组与传统全外阴根治术组3年、5年生存率比较差异无统计学意义(P>0.05);外阴癌根治术加放疗与单纯放疗5年生存率比较差异有高度统计学意义及统计学意义(P<0.05);腹股沟淋巴结阴性患者的5年生存率与阳性患者比较及盆腔淋巴结阴性患者的5年生存率与阳性患者比较差异有高度统计学意义及统计学意义(P<0.01,P<0.05)。结论:临床分期及淋巴结转移状况是对外阴恶性肿瘤的预后具有显著影响的两个因素。外阴恶性肿瘤的治疗方式应具个体化。     

Management of vulvar melanoma.

Considerable debate centers on the optimal treatment for vulvar melanoma, as well as those clinicopathological factors influencing prognosis. We reviewed 80 patients with vulvar melanoma seen between 1949 and 1990. Primary tumors were assessed according to Chung (47 patients) and Breslow (65 patients) microstaging systems. Fifty-nine patients (76%) underwent radical vulvectomy, ten patients (13%) had a partial vulvectomy, and nine patients (12%) had a wide local excision. Fifty-six also underwent inguinal node dissection. Median follow-up was 193 months. Median survival was 63 months. Ten-year survival by Chung level was as follows: I 100%; II, 81%; III, 87%; IV, 11%; V, 33%. Ten-year survival by tumor thickness was as follows: 0.75 mm, 48%; 0.75-1.5 mm, 68%; 1.51-3.0 mm, 44%; greater than 3.0 mm, 22%. Increased depth of invasion was associated with increased incidence of inguinal node metastasis. Cox regression analysis demonstrated prognostic significance for tumor thickness (P less than 0.001), inguinal node metastasis (P less than 0.001), and older age at diagnosis (P less than 0.001). Radical vulvectomy did not seem to improve survival over less radical procedures. Based on this experience, we recommend radical local excision for patients with malignant melanoma of the vulva. Patients who have more than a superficially invasive melanoma should also have inguinal lymph node dissection.     

Radical versus conservative surgery for vulvar carcinoma.

OBJECTIVE: The comparison of the radical and conservative surgical approaches for vulvar carcinoma in relation to the rate of recurrence and complications. METHODS: The records of invasive vulvar carcinoma cases were retrospectively reviewed in Istanbul University, Cerrahpasa School of Medicine, Gynecologic Oncology Division and Social Insurance Institution, Ankara Maternity Hospital, Gynecologic Oncology Department. Surgically treated cases with squamous histology were divided into radical vulvectomy and conservative procedures groups and were compared with respect to recurrence, complications, and disease-free survival. RESULTS: One hundred thirteen cases of invasive vulvar carcinoma cases were of squamous histopathology and 92 of these were surgically treated. The rate of local recurrence was lower in the radical vulvectomy group (25%) compared to conservative procedures groups (42.5%; p>0.05). The complication rates were comparable between the radical vulvectomy and conservative procedures groups (32.7% versus 35%, respectively; p>0.05). At the end of five years of the follow-up, the disease-free survival rates were 51.5% in radical vulvectomy group versus 35.7% in conservative procedures group (p>0.05). CONCLUSION: The rate of recurrence, complication, and disease-free survival are similar for the radical vulvectomy and the conservative procedures. Deciding the surgical strategy for vulvar carcinoma should depend on the experience of the surgeon for the short-term adequate results.     

Behandlungsformen und-Ergebnisse beim invasiven Vulvakarzinom

Between 1970 and 1982, 113 patients were treated for invasive vulvar cancer in FIGO stages I-IV; 97 patients were available for follow-up. Forty-one patients (42.3%) underwent radical vulvectomy and lymphadenectomy, 21 underwent simple vulvectomy, and 12 (12.4%) had electric resection of the lesion; 42 patients (43.3%) received postoperative radiotherapy. The 5-year survival rate was 61.8% after surgery and radiotherapy. Five-year survival in stages I, II, and III was 85.3%, 60.7%, and 17.9%, respectively. Overall 5-year survival was 52.6%. Patients with small, highly differentiated squamous cell cancers, without lymph node involvement, did best.     

Squamous Vulvar Cancer: A Clinically Based Individualization of Treatment

Objective. The aim of the study was to evaluate treatment results in 211 patients with previously untreated squamous cell vulvar cancer who were primary managed by surgery at the Gynecologic Oncology Unit of Alexandra Hospital, in terms of en bloc radical vulvectomy (N = 105), modified radical vulvectomy with three different incisions technique (N = 60), and radical hemivulvectomy (N = 46) with inguinofemoral lymphadenectomy.Methods. The surgical stage of disease, nodal status, lesion location and focality, marginal status, tumor size, physical and performance status, surgical modality used, and finally complications and recurrence rates were the analyzed factors for both survival and disease remission.Results. The overall 5-year survival was 70.1%. The 5-year survival for node-positive patients was 53.8% versus 79.7% for node-negative patients. Unifocal lesions had a 5-year survival of 76% compared with 50% of multifocal lesions. Posterolateral lesions had a better 5-year survival than that of anterior central lesions (79.5% vs 54.4%). The marginal status of the surgical specimen was a significant predictor of both survival and recurrence. There was a significant difference in complications related to the en bloc radical vulvectomy in terms of wound breakdown, infection, and wound cellulitis.Conclusions. Modified radical procedures are equally effective with the en bloc radical vulvectomy for the management of early (stage I/II) vulvar cancer. In advanced disease concervative surgery in an individualized approach could also effectively be applied.     

Squamous cell carcinoma of the vulva: study of ploidy, HPV, p53, and pRb.

Seventy-one cases of invasive squamous cell carcinoma (ISCC) of the vulva were compared with 18 cases of vulvar intraepithelial neoplasia (VIN) and 21 cases of lichen sclerosus. Ploidy was studied by image analysis, HPV-DNA by PCR, and p53 and pRb by immunohistochemistry. Univariate and multivariate statistical analyses were performed. The mean age of the patients with ISCC was 70.6 years; only 8.5% were < 60 (range, 43-89) years. For the 43 patients with follow-up, FIGO surgical stages were I in 16.2%, II in 48.8%, III in 27.9%, and IV in 6.9%. The 5-year survival was 90% for the patients with curative surgery (vulvectomy and lymphadenectomy) and 32% for those with tumors in stages III to IV. Previous history of nonneoplastic epithelial alterations was recorded in 54%. Vascular invasion was detected in 4.3% and perineural invasion in 21.4%. Inguinal lymph node metastases were present in 34.9% of the cases. Fifty-one (72%) ISCCs were aneuploid, HPV-DNA-16 was detected in 7 (12.3%) cases, overexpression of p53 was found in 40 (56%), and pRb expression was negative in 15 (21.4%). Fifteen cases (80%) of VIN were aneuploid, 5 (27.7%) contained HPV-DNA, 11 (61%) were positive for p53, and all immunoreacted for pRb. All lichen sclerosus cases were diploid, did not contain HPV-DNA, failed to stain for p53, and were positive for pRb. Our study confirmed the prognostic value of conventional pathological features: stage, lymph node metastasis, histological grade, and vascular and perineural invasion; all were statistically significant for survival in the univariate analysis. Also, ploidy was significant in patients with stages I and II tumors. The only significant variable in the multivariate analysis was stage. p53 overexpression appears as a late event in vulvar carcinogenesis, but it may occur before tumor invasion. Lack of pRb expression can occur in vulvar neoplasia, but it does not seem to play any role in the initiation or prognosis of vulvar ISCC.     

Radical vulvectomy and bilateral inguinal-femoral lymphadenectomy through separate incisions—experience with 100 cases

Over a 6-year period 100 patients with vulvar cancer were treated by radical vulvectomy and bilateral inguinal femoral lymphadenectomy performed through separate incisions. The average age of the patients was 68.8 years. Ninety patients had squamous carcinoma, six had melanoma and four had other vulvar malignancies. FIGO staging was stage 1–46, stage II-25, and stage III-23, and stage IVa-6. Twenty-seven patients were found to have spread of tumor to groin nodes, 21 unilateral and six bilateral. For patients with squamous carcinomas, groin nodes were positive in four of 45 (8.9%) with tumor diameter < 2 cm vs. 17 of 42 (40.5%) with tumors> 2 cm. In 60 patients with unilateral squamous tumors, no isolated contralateral node metastases were found, however two of 13 patients (15.4%) with positive ipsilateral nodes had positive contralateral nodes also. One patient with negative nodes developed bilateral recurrent tumor in the skin bridges and subsequently died. Overall 5-year survival corrected for death from intercurrent illness was 74.6%. Corrected survival by stage for squamous carcinomas was as follows: stage I-96.7%, stage II-85%, stage III-45.8% and stage IV-50%.     

Have patients with early squamous carcinoma of the vulva been overtreated in the past? The Norwegian experience 1977-1991

OBJECTIVE: To evaluate different surgical approaches in early squamous vulvar cancer. METHODS: Review of clinical and histopathologic data and follow-up information of 216 patients with clinical FIGO stage I-II disease, primarily treated by surgery from 1977-1991. RESULTS: Eighty-nine patients underwent radical vulvectomy with bilateral groin dissection by en bloc excision, 60 by the triple incision technique, 20 individualized vulvar surgery with uni-or bilateral groin dissection, and 47 vulvar surgery only. Groin metastases occurred in 9% stage I and 25% stage II disease. Groin involvement was not seen in stage I tumors with invasion depth < or =/=1 mm. Bilateral metastases occurred in medially located tumors of both stages, and laterally located stage II. Metastases were ipsilateral in lateral stage 1. Separate groin dissection significantly reduced morbidity. Sixty-six patients relapsed, 14 after more than 5 years. Vulvar recurrence was related to tumor diameter and the condition of the resection borders. The single most important predictor of death from vulvar cancer was the presence of inguinal femoral lymph node metastases. Conservative and individualized surgery did not compromise 5-year survival. CONCLUSIONS: A careful selection of patients fitted for less radical surgery is essential to avoid undertreatment. Groin dissection can be omitted in tumors with diameters < or =/=2 cm and invasion depth < or =/=1 mm. At least ipsilateral groin dissection is needed in all other cases. Groin dissection should be performed through separate incisions. Modified vulvectomy is appropriate provided radicality can be obtained. Long-time follow-up is important as recurrences can be seen many years after primary therapy.     

Prognostic factors in patients with carcinoma of the vulva--our own experience and literature review

AIM OF THE STUDY: The objective was the analysis of prognostic factors and treatment outcomes of 104 patients with vulvar cancer, treated between 1990 and 2003 in the Center of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow, Poland. MATERIAL AND METHODS: The median age of patients was 67. Advanced disease (TNM III and IVA) was found in 54 (51.9%) patients and grade 2 and 2 in 50 (48.1%). Inguinal lymph nodes were clinically uni- or bilaterally involved in 40.4% of patients. Fifty-seven (54.8%) patients underwent radical vulvectomy with bilateral inguinal lymphadenectomy and 47 (45.2%) radical vulvectomy only. Cancer differentiation was well in 38 (36.2%) of patients, moderate in 38 (36.2%) and poor in 28 (36.6%). Adjuvant radiotherapy was applied in 30 (28.8%) cases. RESULTS: Five-year overall survival rate was observed in 44.4% of patients. Depending on TNM grade, 5-year OS rates were 61.4% for grade 1, 54.9% for grade 2, 40.1% for grade 3 and 13.3% for IVA. In patients aged < 70, 5-year OS rate was 54.7% compared to 30.5% for those > or = 70. Among patients with G1 cancer differentiation 64.4% survived five years, with G2 39.1% and with G3 24.9%, respectively. CONCLUSION: Univariate analysis revealed a statistically significant, unfavorable impact of age > or = 70, with G3 cancer differentiation, clinically confirmed inguinal lymph node involvement and TNM classification stage on 5-year overall survival. Cox multivariate analysis demonstrated that independent prognostic factors for 5-year survival were the age of the patient, clinical status of inguinal lymph nodes and TNM classification grade.