外阴阴道黑色素瘤的临床病理特征和手术治疗--一项回顾性单中心研究。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery Pub Date : 2024-10-28 DOI:10.1016/j.bjps.2024.10.035

Telma Lumiala, Virve Koljonen, Kaisu Ojala

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引用次数: 0

摘要

背景和目的：外阴黑色素瘤是一种罕见的恶性肿瘤，预后较差。本研究旨在回顾赫尔辛基大学医院治疗的外阴阴道黑色素瘤病例。目的是评估临床病理特征、治疗方法和影响预后的因素：方法：对2001年至2021年间接受治疗的患者进行单中心回顾性研究。数据来自病历。分析临床病理特征、治疗、生存率和预后因素：结果：共有21名患者纳入分析。86%的患者为外阴癌（18 例），14%的患者为阴道癌（3 例）。诊断时的中位年龄为 80 岁。18名患者（86%）的初始治疗包括手术，其中19%为局部广泛切除术，62%为根治性切除术，4.8%为盆腔切除术。83%的患者（15 人）达到阴性边缘。11名患者（52%）接受了腹股沟治疗：33%的患者接受了前哨淋巴结活检，14%的患者接受了直接淋巴结切除术，4.8%的患者同时接受了前哨淋巴结活检和直接淋巴结切除术。九名患者黑色素瘤复发。复发类型包括局部复发（1 例）、远处复发（4 例）以及局部和远处复发（4 例）。中位无病生存期为1890万，中位总生存期（OS）为3650万。5年相对生存率为20%。7名患者（33%）的死因是黑色素瘤。阴道定位往往会使预后恶化。结节状态是唯一与生存率显著相关的黑色素瘤特征。手术根治性并不影响存活率：结论：外阴阴道黑色素瘤的生存率极低，复发率高，主要是远处转移。在局部控制方面，大范围局部切除似乎是根治性手术的可行替代方案。结节状态是一个关键的预后因素，强调了进一步研究前哨淋巴结活检对外阴阴道黑色素瘤的适用性的重要性。

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Clinicopathologic features and surgical management in vulvovaginal melanoma – A retrospective single-center study

Background and aims

Vulvovaginal melanoma is a rare malignancy with a poor prognosis. This study aimed to review cases of vulvovaginal melanoma treated at Helsinki University Hospital. Objective was to evaluate the clinicopathologic features, treatment, and factors affecting outcome.

Methods

A single-center retrospective review was conducted on patients treated between 2001 and 2021. Data were collected from medical records. Clinicopathologic features, treatment, survival, and prognostic factors were analyzed.

Results

A total of 21 patients were included in the analysis. Localization was vulvar in 86% (n = 18) and vaginal in 14% (n = 3). The median age at diagnosis was 80 years. Initial treatment included surgery in 18 patients (86%), with wide local excision in 19%, radical excision in 62%, and pelvic exenteration in 4.8%. Negative margins were achieved in 83% (n = 15). Eleven (52%) patients underwent inguinal treatment: sentinel lymph node biopsy in 33%, direct lymphadenectomy in 14%, and both in 4.8%. Nine patients experienced melanoma recurrence. Recurrences were locoregional (n = 1), distant (n = 4), and both locoregional and distant (n = 4). Median disease-free survival was 18.9M and median overall survival (OS) was 36.5M. The 5-year relative OS was 20%. Melanoma was the cause of death in seven patients (33%). Vaginal localization tended to worsen prognosis. Nodal status was the only melanoma characteristic significantly associated with survival. Surgical radicality did not affect survival.

Conclusions

Vulvovaginal melanoma is associated with extremely poor survival rates and high recurrence rates, primarily involving distant metastasis. In local control, wide local excision seems to be a viable alternative to more radical surgery. Nodal status is a key prognostic factor emphasizing the importance of further research into the applicability of sentinel lymph node biopsy for vulvovaginal melanoma.

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来源期刊

Journal of Plastic Reconstructive and Aesthetic Surgery 医学-外科

CiteScore

3.10

自引率

11.10%

发文量

578

审稿时长

3.5 months

期刊介绍： JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.