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- 저자 : Silvana Privitera (검색결과 2 건)
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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.
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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.
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