外阴癌复发(附55例临床分析)

目的:分析外阴癌外阴局部复发和区域淋巴结转移复发的临床特点及其预后,并探讨外阴癌的治疗。方法:回顾性分析我院1958～2000年收治的435例外阴原发性鳞癌中55例复发患者的临床特点和治疗。结果:复发率为12.6%(55/435)。55例复发患者中,32例单纯外阴局部复发,12例单纯腹股沟淋巴结转移,11例外阴局部复发合并腹股沟淋巴结转移。2年内复发、5年以上至10年内、10年以上复发分别占复发者的49.1%、25.5%、3.6%。外阴单纯复发和腹股沟淋巴结转移复发患者再次治疗后5年生存率分别为49.2%和6.4%,两者差异显著(P<0.01)。结论:单纯外阴复发预后较好,腹股沟淋巴结转移复发预后差。原发外阴癌患者腹股沟淋巴结的处理,仍应以手术治疗为主。为预防外阴局部复发,外阴白斑及其周围皮肤应一并切除,切缘离肿瘤尽可能大于2cm。如果肿瘤接近或侵犯尿道口、肛门而行保留尿道或保肛手术均应于术前或术后辅以放射治疗。     

外阴癌临床治疗309例报告

目的　分析外阴癌不同治疗方法的结果 ,并探讨其复发转移的特征。方法　采用回顾性研究的方法 ,对 30 9例外阴癌的临床治疗结果进行分析。结果　 30 9例患者总的 5年生存率为6 7.9% ,Ⅰ、Ⅱ、Ⅲ及Ⅳ期的 5年生存率分别为 86 .9%、82 .5 %、5 9.2 %和 43.6 %。总的治疗失败率为49 .8% (其中 2年内失败者占 6 9.5 % ) ;复发部位依复发时间不同而异 ,83.6 %的腹股沟、盆腔及远处转移发生在治疗后 2年内 ,外阴局部复发占 2年后治疗失败的 81.1%。外阴癌复发转移与年龄无关。Ⅰ期癌各种治疗方法的生存率及治疗失败率差异无显著性。Ⅱ期癌外阴根治性切除 腹股沟清扫术生存率较高 (P <0 .0 5 ) ;腹股沟淋巴结阳性者 ,手术治疗的失败率显著低于放疗 (P <0 .0 5 ) ;腹股沟淋巴结阴性者 ,两种治疗方式差异无显著性 ;腹股沟预防照射剂量Dm达 6 0Gy者 ,失败率显著低于剂量Dm <6 0Gy者 (P <0 .0 5 )。结论　早期外阴癌应施行外阴根治性切除 ,加施预防性淋巴清扫或腹股沟足量放疗 ;对中晚期患者 ,争取切除原发灶及行腹股沟淋巴清扫 ,并辅以术前、术后放疗。     

外阴阴道恶性黑色素瘤20例临床分析

目的:研究原发女性外阴阴道恶性黑色素瘤的临床特点、治疗和预后.方法:系统回顾本院自1976年6月-2006年3月收治的20例原发性女性外阴阴道恶性黑色素瘤的临床资料.结果:本组病例平均年龄48.5岁,绝经后妇女占55%.20例病例中手术治疗19例,1例仅行腹壁下动脉化疗.术后发现8例外阴恶性黑色素瘤患者腹股沟淋巴结转移2例,12例阴道恶性黑色素瘤中,腹股沟淋巴结转移2例,盆腔淋巴结转移2例.外阴恶性黑色素瘤的5年生存率为25%,平均生存期为40.7个月,阴道恶性黑色素瘤的5年生存率为16.7%,平均生存期为19.7个月.结论:女性外阴阴道恶性黑色素瘤是一类恶性程度高,预后差的肿瘤,手术是治疗的主要手段,临床分期,肿瘤部位,病灶大小,淋巴结转移及治疗方法是影响预后的因素;局部复发和早期转移是预后差的主要原因.     

手术治疗外阴恶性肿瘤临床护理分析

目的 :回顾分析外阴恶性肿瘤外科治疗的预后及其影响因素。方法 :回顾分析了山东省肿瘤医院 1971～ 1999年收治的 71例经手术治疗的外阴恶性肿瘤患者临床资料。结果 :中位发病年龄 5 7 9岁 ;Ⅰ期 8例、Ⅱ期 32例、Ⅲ期 2 2例、Ⅳ期 6例、复发者 3例 ;鳞癌 5 2例、恶性黑色素瘤 9例、其他类型 10例 ;行腹股沟淋巴结清除术者 4 5例 ,未清除者 2 6例。外阴区伤口Ⅰ期愈合 5 7例 (80 % ) ,腹股沟区伤口Ⅰ期愈合 32例 (71.1% )。总 5年生存率为 5 0 9% (2 9/ 5 7) ,较早期 (Ⅰ、Ⅱ )患者 5年生存率均高于晚期 ,伤口愈合情况对预后有一定的影响。结论 :①早期发现、早期诊断、早期治疗对外阴癌的治疗预后尤为重要。②手术切除是外阴癌的主要治疗手段 ,手术方式的选择应个体化 ,对病期较早淋巴结转移率小的患者可试行单纯外阴切除 ,术后给予放疗或化疗。③外阴复发癌亦应积极创造再治疗机会 ,如处理得当 ,可挽救或延长患者生命。④加强护理 ,促进伤口愈合 ,及时治疗利于提高生存率     

外阴转移性癌60例临床分析

〔目的〕探讨外阴转移性癌的诊断和治疗。〔方法〕对60例外阴转移性癌临床资料进行回顾性分析。〔结果〕60例外阴转移性癌 ,主要继发于宫颈癌和宫体癌 ,3年、5年生存率分别为30 15%和20 10 %。综合治疗5年生存率(手术加化疗24 10 %、放疗加化疗18 60 %)明显优于单纯化疗(10 96 %)和单纯放疗(14 54%)。转移灶大于2cm或多发或伴有原发肿瘤复发/远处转移者生存率较差。〔结论〕外阴转移性癌预后差 ,综合治疗可提高生存率从而延长生命。     

127例原发齿龈鳞状细胞癌预后分析

目的:探讨原发齿龈鳞状细胞癌最佳治疗方法及影响预后的因素.方法:分析我院1978年1月至1998年12月收治的127例原发齿龈鳞状细胞癌患者,观察其临床疗效.结果:127例中单纯手术18例,单纯放疗37例,术后放疗9例,术前放疗22例,化疗加手术31例,姑息化疗10例;5年生存率分别为27.5%、20.4%、66.7%、72.7%、50.2%和0.结论:齿龈鳞状细胞癌首选手术治疗,放疗和(或)化疗,是预防单纯手术后复发或放疗后局部未控的有效方法.综合治疗可以提高齿龈鳞状细胞癌的预后;影响预后的主要因素有治疗方法、分期、淋巴结转移和发病部位等.     

72例乳腺浸润性乳头状癌的临床分析

目的:分析乳腺浸润性乳头状癌的临床病理特征及影响腋窝淋巴结转移和预后的相关因素.方法:收集2000年4月～2008年1月天津医科大学附属肿瘤医院乳腺科收治的72例乳腺浸润性乳头状癌患者的临床病理资料,分析影响浸润性乳头状癌腋窝淋巴结转移的临床病理因素.Kaplan-Meier法计算生存率,Log-rank检验进行生存率显著性检验,Cox比例风险模型用于单因素、多因素分析,评价各因素对预后的影响.结果:72例乳腺浸润性乳头状癌的3年、5年生存率分别为89.7%、83.7%.肿瘤大小及病程长短与浸润性乳头状癌腋窝淋巴结的转移存在相关性.单因素生存分析显示:ER、PR的表达状况及治疗方法的选择是影响乳腺浸润性乳头状癌预后的相关因素.Cox多因素分析则显示仅治疗方法的选择是影响预后的独立因素.结论:乳腺浸润性乳头状癌是一种多发生于绝经后妇女、预后较好的浸润性特殊型癌,其治疗方法的选择对患者的预后有重要影响,该类型乳腺癌应在个体耐受的情况下行手术联合其他治疗方法的综合治疗以提高患者的生存率.     

三阴乳腺癌的临床病理特征和预后分析

背景与目的:三阴性乳腺癌(triple negative breast cancer,TNBC)是一类高危乳腺癌,其雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone,PR)和入表皮生长因子受体2(human epidermal growth factor receptor-2.Her-2)表达均为阴性,因而不能从针对激素受体的内分泌治疗和Her-2的靶向治疗中获益.本研究旨在分析TNBC患者的临床病理特征、生存情况和预后影响因素.方法:收集免疫组织化学检测ER、PR和Her-2均为阴性的128例乳腺癌患者的临床病理资料,观察其长期生存情况.结果:所有患者中,浸润性导管癌占89.0%.T1、T2患者占78.1%,有淋巴结转移的患者占48.4%,Ⅰ、Ⅱ期患者占60.9%.5年无病生存率、无局部复发生存率、无远处转移生存率和总生存率分别为71.1%、84.3%、75.8%和83.6%.单因素分析结果显示,淋巴结转移、肿块大小、分期和脉管癌栓与TNBC预后有关.多因素分析显示,淋巴结转移(RR=17.449,P=0.000)、原发肿块大小(RR=31.237,P=0.000)是影响TNBC预后的因素.结论:TNBC有明显不同的临床病理特征,发病时常年轻、有淋巴结转移、肿块较大,有乳腺癌家族史,预后差,淋巴结转移和肿块大小是影响TNBC预后的因素.     

早期乳腺癌患者预后因素分析

目的:研究T1～T2、0～3枚阳性淋巴结乳腺癌患者肿瘤复发和生存的预后因素.方法:回顾分析天津医科大学附属肿瘤医院收治的540例乳腺癌患者资料.进行单因素变量分析及Cox回归分析肿瘤复发和生存的预后因素.结果:>20%阳性腋窝淋巴结率是影响肿瘤局部复发的预后因素(HR=12.816,P<0.001);>20%阳性淋巴结率和浸润性导管癌是影响肿瘤远处转移的预后因素(HR=11.088,P<0.001;HR=0.390,P=0.018);1～3枚阳性淋巴结和>20%阳性淋巴结数是显著影响10年总生存率的预后因素(HR=2.110,P=0.001;HR=10.244,P<0.001),二者也是影响10 年无瘤生存率的预后因素(HR=1.634,P=0.004;HR=7.339,P<0.001).结论:腋窝淋巴结有无转移是影响10年局部复发,远处转移,总生存率和无瘤生存率的重要的预后因素.原发肿瘤组织病理是显著影响10年肿瘤远处转移的预后因素.     

原发性肺类癌27例诊治及预后分析

背景与目的:原发性肺类癌较少见,且术前诊断较困难.本文总结肺类癌的临床病理特点、诊断及治疗方法,评价影响预后的因素.方法:收集1981-2006年我院经手术病理证实的27例原发性肺类癌的临床资料,对其影像学及手术前后的病理学检查结果等进行分析,并采用统计学方法观察生存率及其影响因素.结果:病灶部位:周围型10例(37%),中央型17例(63%).原发肿瘤平均大小3.2 cm.全组均行手术治疗,其中6例(22%)有淋巴结转移.术后病理结果显示,病理类型:典型类癌(typical carcinoid,TC)20例,非典型类癌(atypical carcinoid,AC)7例.其中Ⅰ期21例、Ⅱ期4例、Ⅲ期2例.术后加放化疗3例、单纯化疗2例.全组5年和10年生存率分别为85%和68%.典型类癌的5年生存率为97%,而非典型类癌为65% (P= 0.021).有无淋巴结转移的5年生存率分别为56%和93%(P＜ 0.001).预后分析示病理类型和淋巴结是否有转移为有显著性意义的预后因素.结论:肺类癌以手术治疗为主,预后良好.多数肺类癌患者术后可获得长期生存,影响预后的主要因素为病理类型和淋巴结是否累及.     

Radiation treatment in recurrent squamous cell cancer of the vulva

Purpose: To evaluate the treatment and outcome of recurrent vulvar cancer.

Methods and Materials: In a retrospective review of 26 women referred to the department of radiation oncology between 1982 and 1995, patient records were analyzed with respect to the findings at original surgery, the time to locoregional recurrence, the location of the recurrence, and the subsequent management and outcome.

Results: Sixteen recurrences were managed with a combination of surgery and radiotherapy, and the remainder with radiation treatment, combined with chemotherapy in some cases. The overall survival for the entire cohort at 5 years was 22%. The 5-year survival for those with recurrence confined to the vulva (n = 13) was 46%, compared with 0% for those women with a recurrence located or extending beyond the vulva (p = 0.002). The local control rate was 34.6%.

Conclusion: Our results confirm the poor overall prognosis for this condition. In particular, they highlight the importance of the location of the recurrence as a prognostic indicator. Based on this review, we conclude that radiotherapy fields should encompass the region at risk if the intent is curative. Finally, low-dose palliation for groin node recurrence is ineffectual.     

Midline Involvement as a Risk Factor for Vulvar Cancer Recurrence

Objective: This observational study was to identify risk factors for vulvar cancer recurrence. Materials andMethods: In the study 107 patients with primary vulvar cancer were analyzed. Surgical treatment consistedof radical excision of the primary tumor in combination with unilateral or bilateral superficial and deepinguinofemoral lymphadenectomy through separate incisions. Patients with deeper tumor invasion >1 mm orwider than 2 cm and/or groin lymphnode metastases were referred for adjuvant radiotherapy. Those with largeprivary vulvar tumors received neoadjuvant radiotherapy of 30Gy followed by surgical treatment and adjuvantradiotherapy. Results: Most of patients had only primary radiotherapy to the vulva and inguinal lymph nodesand only 34.5% of patients were eligible for surgical treatment. In 5 year follow-up period 25.2% (27) patientswere alive without the disease, 15.0% (16) were alive with the disease and 59.8% (64) were dead. 60.7% (65)patients experienced local recurrence and 2.8% (3) patients had distant metastases. Median survival for patientswithout recurrent disease was 38.9±3.2 months and 36.0±2.6 months with no statistically significant difference.Patients with early stage vulvar cancer had longer mean survival rates-for stage I 53.1±3.4 months, 38.4±4.4months for stage II and 33.4±2.6 and 15.6±5.2 months for patients with stage III and stage IV vulvar cancer,respectively. The only signifficant prognostic factor predicting vulvar cancer recurrence was involvement of themidline. Conclusions: Patients having midline involvement of vulvar cancer has lower recurrence risk, probablybecause of receiving more aggressive treatment. There is a tendency for lower vulvar cancer recurrence risk forpatients over 70 years of age and patients who are receiving radiotherapy as an only treatment without surgery,but tendency for higher risk of recurrence in patients with multifocal vulvar cancer.     

Groin recurrence in carcinoma of the vulva: management and outcome

CORMIO G., LOIZZI V., CARRIERO C., CAZZOLLA A., PUTIGNANO G. & SELVAGGI L. (2010) European Journal of Cancer Care 19 , 302–307
Groin recurrence in carcinoma of the vulva: management and outcome The aim of the study was to investigate the management and outcome of inguinal recurrence in vulvar carcinoma patients. A retrospective chart review was conducted on 140 patients with squamous cell carcinoma of the vulva treated between 1994 and 2006. Twenty‐one patients were found to have groin recurrence. Median interval between primary treatment of vulvar cancer and groin recurrence was 7 months. Three patients refused any treatment, 3 received chemotherapy, 2 inguino‐pelvic radiotherapy and 13 had resection of the groin recurrence. After surgery seven patients received irradiation of the groin and pelvis, and three patients received chemotherapy. One patient died following surgery; 19 patients died of disease with the median survival after diagnosis of inguinal recurrence of 9 months. Only one patient is alive without evidence of disease at 60 months following surgery. In univariate analysis, stage and grade at diagnosis, age and performance status at the recurrent disease, and the extent of residual tumour after resection of groin recurrence were predictors for survival. Groin recurrences from vulvar carcinoma carry a poor prognosis. Multi‐modal treatment may result in a palliation of the disease, and a very limited number of patients have long‐term survival.     

Patterns of recurrence in patients with squamous cell carcinoma of the vulva. A multicenter CTF Study

BACKGROUND: Invasive vulvar carcinoma is a rare disease with an incidence rate of 3-5% of all female genital neoplasms. The current study discusses the limited number of articles in the literature regarding the patterns of recurrence as well as the clinical outcome of patients with recurrent disease based on a consistent and consecutive series of cases. METHODS: A common clinical chart focusing on the study of patterns of recurrence was used in five Italian gynecologic institutions with uniform criteria of surgical nomenclature, pathologic variables, and sites of recurrence. Between 1980-1994, 502 cases of primary invasive squamous carcinoma of the vulva were registered consecutively, treated, and considered for this multicentered study. RESULTS: Of 502 patients, 187 (37.3%) developed a recurrence. Distribution of the recurrences by site was as follows: perineal, 53.4%; inguinal, 18.7%; pelvic, 5.7%; distant, 7.9%; and multiple, 14.2%. In a multivariate analysis, 3 characteristics appeared to be statistically correlated with the risk of recurrence: International Federation of Gynecology and Obstetrics Stage > II (P = 0.029), positive lymph nodes (P = 0.009), and vascular space invasion (P = 0.004). The 5-year survival rate was 60% for perineal recurrences, 27% for inguinal and pelvic recurrences, 15% for distant recurrences, and 14% for multiple recurrences. CONCLUSIONS: In the current study the prognostic factors found to have statistical significance as prognostic factors for risk of recurrence were tumor dimension, lymph node involvement, and stromal and vascular space invasion. The presence of inguinal lymph node metastases was predictive of multiple and distant recurrences with a low rate of incidence of isolated perineal recurrence (27%) compared with negative lymph node cases (57.5%). Survival analysis of recurrent disease showed that the surgical resection of local recurrences may provide acceptable results (51% at 5 years). This observation may justify a follow-up program aimed at identifying those patients with early local recurrence suitable for radical resection.     

Systemic treatment of vulvar cancer

Squamous cell carcinoma of the vulva is a rare disease, accounting for approximately 5% of cancers of the female genital tract. Standard therapy for early-stage vulvar cancer mainly comprises of surgery of the vulva and groins. In locally advanced or metastatic vulvar cancer, neoadjuvant or definitive chemoradiation is often considered as an alternative treatment option. Given its rarity, the level of evidence for different treatment modalities is poor and few clinical trials have been performed on this disease. Therefore indication criteria for systemic treatment in advanced stage vulvar cancer vary widely among countries and institutions. This review focuses on the different systemic treatment options for patients with locally advanced, recurrent or metastatic vulvar cancer, and highlights the need for an international multicenter approach to identify the most effective therapeutic options.     

125例复发/持续性分化型甲状腺癌再次手术及其预后影响因素分析

背景与目的：分化型甲状腺癌虽然预后良好,但仍有一部分患者存在复发和（或）转移风险。通过总结再次手术的125例复发/持续性分化型甲状腺的临床资料,探讨其复发/持续原因及部位、再次手术风险及其预后的影响因素。方法：回顾性分析中国医学科学院北京协和医学院北京协和医院2008—2017年同一组医生收治的行手术治疗的复发/持续性性分化型甲状腺癌患者的病历资料。采用2015年美国甲状腺协会动态危险度评估系统对术后随访患者的治疗反应进行评估分级。结果：患者共125例,其中男性26例,女性99例;平均年龄42岁。再次手术原因包括残余腺体复发/持续45例（45/125,36.0%）,中央组淋巴结复发/持续56例（56/125,44.8%）,侧方淋巴结复发/持续58例（58/125,46.4%）。再次手术后并发症包括新发的永久性甲状旁腺功能减退者3例（3/125,2.4%）,喉返神经麻痹者4例（4/125,3.2%）。患者术后平均随访61个月,5年完全缓解率为69.6%（87/125）。多因素分析结果显示,既往手术次数是影响患者预后的独立危险因素（OR=2.948,95% CI：1.125~7.725,P=0.028）。结论：残余腺体及局部淋巴结复发/持续是分化型甲状腺癌持续/复发的主要原因。再次手术风险较高,但有经验的甲状腺专科医生可以将风险控制在较低水平。分化型甲状腺癌复发/持续后再次手术治疗预后良好,既往手术次数是影响患者预后的独立危险因素。     

131I在复发性甲状腺乳头状癌临床诊治中的价值

甲状腺乳头状癌（PTC）总体预后良好,但首次治疗后仍可能有高达20%~30%的患者复发,并因此导致预后不良和治疗困难。¹³¹I是初治中高危风险PTC患者术后重要的辅助治疗手段,仍可在复发性PTC诊治中发挥重要作用,诊断方面可帮助早期发现并准确定位复发灶、评估摄碘能力、指导制定治疗方案;治疗上可作为微小复发灶根治性治疗、可手术切除病灶再次术后辅助治疗和晚期不可切除病灶姑息治疗的一部分。本文重点综述131I在复发PTC再次术后辅助治疗中的价值。     

宫颈癌手术治疗后阴道残端复发灶的放射治疗

目的：研究３８例狗颈癌术后阴道残端复发放疗的疗效及预后的有关因素。方法：３８例患者中,２５例为单纯阴道残端复发,１３例为阴道残端合并盆腔复发。根据阴道残端肿瘤大小分为３组,Ａ组：肿瘤直径≥３ｃｍ,Ｂ组：肿瘤直径〈３ｃｍ,Ｃ组：肿瘤结节不明显。采用阴道高剂量率后装加盆腔外照射治疗。结果：１７例患者治疗后存活期超过５年,五年生存率为４４．７％;其中Ａ组五年生存率２３．１％（３／１３）,Ｂ组五年生存率３     

Preliminary results of chemoradiation as a primary treatment for vulvar carcinoma

PURPOSE: To assess the role of chemoradiation as a primary treatment for vulvar carcinoma. METHODS AND MATERIALS: Between December 1989 and August 1997, there were 14 patients with the diagnosis of squamous cell carcinoma of the vulva. Two patients were excluded from this study because of advanced stage at presentation. Key information about the remaining 12 patients was extracted from their charts. All patients had biopsy prior to treatment, and were treated with chemoradiation. Radiation was administered to the vulva only. Surgical biopsies from the vulva and inguinal nodal dissection were done 4-6 weeks after radiation treatment. All patients were followed for evaluation of response and clinical detection of recurrence. The period of follow-up ranged from 8 to 125 months. Mean follow-up period was 41 months. RESULTS: All 12 patients showed complete response to the treatment. Only 1 patient (8.3%) developed local recurrence at 3 months posttreatment. Another patient (8.3%) developed nodal recurrence at 30 months posttreatment. Both patients were salvaged by surgical treatment and remained disease free. The actuarial 5-year disease-free survival was 43%. The actuarial 3-year disease-free survival was 84%. The majority of patients developed mild-to-moderate complications due to chemoradiation. These were well tolerated and responded to medical treatment. None of the patients developed late complications to chemoradiation treatment. CONCLUSIONS: Chemoradiation is an effective primary treatment for vulvar carcinoma as shown by these successfully managed cases.