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Leonardo Micheletti,Mario Preti,Viviana Cintolesi,Elisabetta Corvetto,Silvana Privitera,Eleonora Palmese,Chiara Benedetto 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.5
Objective: We aimed to identify the minimum tumor-free margin distance conferring long-term oncological safety in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB/II vulvar squamous cell carcinoma (VSCC). Methods: This was a retrospective cohort study in patients with stage IB/II VSCC treated at a single institution in Turin, Italy. The main aim was to identify the minimum tumor-free margin distance that confers oncological safety in early-stage VSCC. Patients were divided in groups according to tumor-free histological margin distance to compare survival outcomes. Overall survival (OS), disease-specific survival (DSS), and recurrence rate (RR) were estimated by the Kaplan-Meier method for the newly proposed and the currently recommended 8 mm margin cut-off. Log-rank test was used to compare survival between groups. Results: One hundred and fourteen patients met the study criteria. Median age was 68 years and median follow-up was 80 months. The minimum margin distance that conferred long-term oncological safety was 5 mm. OS, DSS were significantly lower in the <5 mm group when compared with the ≥5 mm group (p=0.002 and p=0.033, respectively) although no difference in RR was observed between groups. Analysis at the 8-mm cut-off indicated there is no difference in OS, DSS, or RR between groups. Conclusion: FIGO stage IB/II VSCC patients' prognosis is affected by margin distance. Long-term survival is significantly reduced in patients with tumor-free margins <5 mm, even in the absence of lymph node metastasis. Thus, these patients should be offered further surgical or adjuvant treatment.
Mario Preti,Lauro Bucchi,Bruno Ghiringhello,Silvana Privitera,Valentina Frau,Elisabetta Corvetto,Chiara Benedetto,Leonardo Micheletti 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.4
Objective: To evaluate the prevalence and risk factors for unrecognized invasive carcinomain a series of patients undergoing surgical excision after an office biopsy of vulvar high-gradesquamous intraepithelial lesion (VHSIL). Methods: Two hundred and sixteen consecutive patients treated in a tertiary-level referralcenter for vulvar disease in north-western Italy were recruited. Patients' records werereviewed by trained personnel. Factors showing a statistically significant (p<0.05) associationwith detection of stromal invasion at excisional surgery in univariate analysis were furtherexamined in a backward stepwise multiple logistic regression model. Results: The median patient age was 50 years (range, 19–88). More than 25% patients withVHSIL at biopsy had associated cervical/vaginal intraepithelial neoplasia, and more than 35%had a multifocal lesion. Invasive carcinoma was detected in surgical specimens from 24 patients(11%). The depth of stromal invasion varied between 0.1 mm and 3.0 mm with a median of 0.5mm. In multivariate analysis, the risk of invasive carcinoma detection was greater for patients inthe highest tertile of age (p=0.008), for patients with a lesion ≥20 mm in size (p=0.013) and withclitoral involvement (p<0.001), and for patients presenting with a nodular lesion (p=0.078). Conclusion: Our study suggests that patient age, lesion size, clitoral involvement andnodular appearance in patients with VHSIL at vulvoscopy-directed biopsy are independentlyassociated with the risk of unrecognized invasive carcinoma.