Prognostic significance of epithelial disorders adjacent to invasive vulvar carcinomas

R Rouzier, P Morice, C Haie-Meder, C Lhomme, M F Avril, P Duvillard, D Castaigne
Gynecologic Oncology 2001, 81 (3): 414-9

OBJECTIVE: Epithelial disorders are found adjacent to vulvar carcinoma in 70-80% of patients. Epithelial disorder may be human papillomavirus related [undifferentiated high-grade vulvar intraepithelial neoplasia (VIN III)] or not [vulvar lichen sclerosus and squamous cell hyperplasia with or without atypia (differentiated VIN III)]. The aim of this study was to evaluate the impact of associated epithelial disorders on the outcome of patients with cancer of the vulva.

METHODS: A retrospective study about 108 patients treated for a squamous cell carcinoma of the vulva was performed. Clinical, surgical, histopathologic, and follow-up data were collected and analyzed.

RESULTS: Seventy-seven patients had an epithelial alteration adjacent to the invasive squamous carcinoma. Squamous cell hyperplasia and lichen sclerosus were identified in 48% (n = 52) and undifferentiated VIN III in 23% (n = 25). The 5-year disease-free and overall survival rates were 39 and 55%, respectively. In univariate analysis, age <70, a tumor size <2 cm, depth of invasion < or =1 mm, tumor thickness < or =5 mm, negative lymph node pathology, lymph node resection, and undifferentiated VIN III were predictive of survival. Using Cox's proportional hazards method, undifferentiated VIN III (P = 0.02), depth of invasion < or =1 mm (P < 0.01), and a pathological negative node status (P < 0.01) were independent predictors of survival. Patients without associated epithelial alterations had clinical and prognostic features comparable to those of patients with vulvar lichen sclerosus and squamous cell hyperplasia.

CONCLUSION: The results of this study support the view that histological evidence of epithelial alterations adjacent to invasive carcinoma can serve to separate patients that differ in terms of prognosis.

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