Surgical margin status and recurrence pattern in invasive vulvar Paget’s disease: A Japanese Gynecologic Oncology Group study
| Autor: | Takayuki Enomoto, Hirokazu Usui, Shinya Matsuzaki, Koji Matsuo, Shin Nishio, Seiji Kagami, Haruko Iwase, Mikio Mikami, Shu Soeda, Ryutaro Nishikawa |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Reconstructive surgery Surgical margin Gynecologic oncology 03 medical and health sciences 0302 clinical medicine Japan medicine Adjuvant therapy Humans Aged Simple Vulvectomy Vulvar Neoplasms business.industry Obstetrics and Gynecology Retrospective cohort study Surgery Paget Disease Extramammary 030104 developmental biology Oncology 030220 oncology & carcinogenesis Radical Vulvectomy Female Neoplasm Recurrence Local Positive Surgical Margin business |
| Zdroj: | Gynecologic Oncology. 160:748-754 |
| ISSN: | 0090-8258 |
| Popis: | To examine the association between surgical margin status and recurrence pattern in invasive vulvar Paget's disease.This is a preplanned secondary analysis of a previously organized nationwide retrospective study in Japan (JGOG-1075S). Women with stage I-IV invasive vulvar Paget's disease who received surgical treatment from 2001-2010 were examined (n=139). Multivariable analysis was performed to assess local-recurrence, distant-recurrence, and all-cause mortality based on surgical margin status.The median age was 70 years. The majority had stage I disease (61.2%), and the median tumor size was 5.0cm. Nodal metastasis was observed in 15.1%. Simple vulvectomy (46.0%) was the most common surgery type followed by radical vulvectomy (28.1%). More than half received vulvar reconstructive surgery (59.0%). Positive surgical margin was observed in 35.3%, and close margin1cm was observed in 29.5%. Vulvectomy type was not associated with surgical margin status (P=0.424). The median follow-up was 5.8 years. Positive surgical margin was associated with increased local-recurrence (5-year cumulative rates for positive versus negative margin: 35.8% versus 15.0%, P=0.010) but not distant-recurrence (18.3% versus 16.0%, P=0.567). Positive surgical margin was also associated with increased all-cause mortality (5-year overall survival rates for positive versus negative margin: 72.6% versus 88.2%, P=0.032). In multivariable analysis, positive surgical margin remained an independent factor associated with increased risk of local-recurrence (hazard ratio 2.80, 95% confidence interval 1.18-6.63) and all-cause mortality (hazard ratio 2.87, 95% confidence interval 1.20-6.83).Positive surgical margin appears to be common in invasive vulvar Paget's disease that is associated with increased local-recurrence and all-cause mortality risks. Role of alternative surgical technique or adjuvant therapy merits further investigation to improve local disease control. |
| Databáze: | OpenAIRE |
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