Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia

Fehr, Mathias K.; Baumann, Marc; Mueller, Michael; Fink, Daniel; Heinzl, Siegfried; Imesch, Patrick; Dedes, Konstantin (2013). Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia. Journal of gynecologic oncology, 24(3), pp. 236-241. Korean Society of Gynecologic Oncology 10.3802/jgo.2013.24.3.236

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OBJECTIVE The malignant potential of intraepithelial neoplasia of the vulva and vagina after treatment is not well defined. Our objective was to examine risk factors for recurrence and invasive disease. METHODS Four hundred sixty-four women with biopsy proven high-grade intraepithelial neoplasia of the vulva and vagina were identified in the electronic databases of four colposcopy clinics. Inclusion criteria were a follow-up of more than one year, no history of invasive cancer and no invasive cancer within the first year after initial treatment. We investigated the potential factors associated with recurrence and progression using a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Of the 411 eligible patients, 123 patients (29.9%) recurred later than one year after initial treatment and 24 patients (5.8%) progressed to invasive disease. According to multivariate analyses, the risk factors associated with recurrence were multifocality (OR, 3.33; 95% CI, 2.02 to 5.51), immunosuppression (OR, 2.51; 95% CI, 1.09 to 5.81), excision as initial treatment (vs. laser evaporation; OR, 1.79; 95% CI, 1.11 to 2.91) and smoking (OR, 1.61; 95% CI, 1.02 to 2.55). Risk factors for progression to invasive disease were immunosuppression (OR, 4.00; 95% CI, 1.30 to 12.25), multifocality (OR, 3.05; 95% CI, 1.25 to 7.43) and smoking (OR, 2.97; 95% CI, 1.16 to 7.60), but not treatment modality. CONCLUSION Laser evaporation combined with extensive biopsy is at least as efficacious as initial treatment of intraepithelial neoplasia with excision. Smoking is a risk factor for both recurrence and progression to invasive disease. Hence, smoking cessation should be advised and maintaining a long follow-up period due to late relapses is necessary.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Gynaecology

UniBE Contributor:

Baumann, Marc and Mueller, Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2005-0380

Publisher:

Korean Society of Gynecologic Oncology

Language:

English

Submitter:

Nathalie Ursula Becher

Date Deposited:

25 Jun 2014 15:35

Last Modified:

13 Dec 2014 11:27

Publisher DOI:

10.3802/jgo.2013.24.3.236

PubMed ID:

23875073

Uncontrolled Keywords:

Cancer, Intraepithelial neoplasia, Laser evaporation, Vagina, Vulva

BORIS DOI:

10.7892/boris.54053

URI:

https://boris.unibe.ch/id/eprint/54053

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