Differentiated vulvar intraepithelial neoplasia long‐term follow up and prognostic factors: An analysis of a large historical cohort
Abstract Introduction Differentiated vulvar intraepithelial neoplasia (dVIN) is a high‐risk preinvasive vulvar lesion and precursor of human papillomavirus‐independent vulvar squamous cell carcinoma (VSCC). Due to its rarity, literature data on its malignant potential are scant. The aim of the study...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-06-01
|
| Series: | Acta Obstetricia et Gynecologica Scandinavica |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/aogs.14814 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849687647197331456 |
|---|---|
| author | Niccolò Gallio Mario Preti Ronald W. Jones Fulvio Borella Linn Woelber Luca Bertero Sara Urru Leonardo Micheletti Federica Zamagni Federica Bevilacqua Pierluigi Tondo Benedetta Pollano Paola Cassoni Chiara Benedetto |
| author_facet | Niccolò Gallio Mario Preti Ronald W. Jones Fulvio Borella Linn Woelber Luca Bertero Sara Urru Leonardo Micheletti Federica Zamagni Federica Bevilacqua Pierluigi Tondo Benedetta Pollano Paola Cassoni Chiara Benedetto |
| author_sort | Niccolò Gallio |
| collection | DOAJ |
| description | Abstract Introduction Differentiated vulvar intraepithelial neoplasia (dVIN) is a high‐risk preinvasive vulvar lesion and precursor of human papillomavirus‐independent vulvar squamous cell carcinoma (VSCC). Due to its rarity, literature data on its malignant potential are scant. The aim of the study is to assess the risk of developing VSCC in patients surgically treated for dVIN not associated with VSCC (solitary dVIN) and the risk of VSCC recurrence in patients treated for dVIN associated with VSCC (dVIN‐VSCC) at first diagnosis. Material and methods A historical cohort study was performed in a northern Italy referral center for vulvar neoplasms. All consecutive women surgically treated for histologically confirmed dVIN from 1994 to 2021 were collected. Primary outcome was cancer risk or recurrent cancer risk, secondary outcomes were risk factors associated with VSCC development or recurrence. Kaplan–Meier method and log‐rank test were used to estimate cancer risk or recurrent cancer risk differences and uni‐ and multivariate Cox regression analyses to identify risk factors associated with VSCC development in solitary dVIN and recurrence of dVIN‐VSCC. Results Seventy‐six patients with dVIN at preoperative biopsy were included: at excisional specimens 44 were solitary dVIN and 32 were dVIN‐VSCC. The absolute risk of VSCC development after solitary dVIN treatment was 43.2% with median time to to VSCC diagnosis of 25.4 months (range 3.5–128.0 months). VSCC recurrence absolute risk in treated dVIN‐VSCC patients was 31.3% with median time to VSCC recurrence of 52.9 months (range 6.5–94.8 months). At uni‐ and multivariate regression analyses, only compliant topical ultrapotent corticosteroid treatment after solitary dVIN excision showed an ability to prevent VSCC development. No protective effect by corticosteroid treatment was shown for VSCC recurrence in dVIN‐VSCC patients. Smoking was associated with higher cancer recurrence risk in dVIN‐VSCC patients on both uni‐ and multivariate regression analyses. Conclusions Patients with dVIN have a high risk of developing both primary and recurring VSCC. Early recognition, long‐term follow up, and compliant ultrapotent topical corticosteroid treatment are recommended. |
| format | Article |
| id | doaj-art-1d93ffc976e24dedb9ae0fad38afefc8 |
| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-1d93ffc976e24dedb9ae0fad38afefc82025-08-20T03:22:16ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-06-0110361175118210.1111/aogs.14814Differentiated vulvar intraepithelial neoplasia long‐term follow up and prognostic factors: An analysis of a large historical cohortNiccolò Gallio0Mario Preti1Ronald W. Jones2Fulvio Borella3Linn Woelber4Luca Bertero5Sara Urru6Leonardo Micheletti7Federica Zamagni8Federica Bevilacqua9Pierluigi Tondo10Benedetta Pollano11Paola Cassoni12Chiara Benedetto13Division of Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science University Hospital, S. Anna Hospital University of Turin Turin ItalyDivision of Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science University Hospital, S. Anna Hospital University of Turin Turin ItalyRetired Clinical Professor Auckland New ZealandDivision of Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science University Hospital, S. Anna Hospital University of Turin Turin ItalyDepartment of Gynecology University Medical Center Hamburg‐Eppendorf Hamburg GermanyDepartment of Medical Sciences, Pathology Unit, City of Health and Science University Hospital University of Turin Turin ItalyDepartment of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health University of Padua Padua ItalyDivision of Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science University Hospital, S. Anna Hospital University of Turin Turin ItalyEmilia‐Romagna Cancer Registry Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori Forlì ItalyDivision of Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science University Hospital, S. Anna Hospital University of Turin Turin ItalyDivision of Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science University Hospital, S. Anna Hospital University of Turin Turin ItalyDivision of Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science University Hospital, S. Anna Hospital University of Turin Turin ItalyDepartment of Medical Sciences, Pathology Unit, City of Health and Science University Hospital University of Turin Turin ItalyDivision of Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science University Hospital, S. Anna Hospital University of Turin Turin ItalyAbstract Introduction Differentiated vulvar intraepithelial neoplasia (dVIN) is a high‐risk preinvasive vulvar lesion and precursor of human papillomavirus‐independent vulvar squamous cell carcinoma (VSCC). Due to its rarity, literature data on its malignant potential are scant. The aim of the study is to assess the risk of developing VSCC in patients surgically treated for dVIN not associated with VSCC (solitary dVIN) and the risk of VSCC recurrence in patients treated for dVIN associated with VSCC (dVIN‐VSCC) at first diagnosis. Material and methods A historical cohort study was performed in a northern Italy referral center for vulvar neoplasms. All consecutive women surgically treated for histologically confirmed dVIN from 1994 to 2021 were collected. Primary outcome was cancer risk or recurrent cancer risk, secondary outcomes were risk factors associated with VSCC development or recurrence. Kaplan–Meier method and log‐rank test were used to estimate cancer risk or recurrent cancer risk differences and uni‐ and multivariate Cox regression analyses to identify risk factors associated with VSCC development in solitary dVIN and recurrence of dVIN‐VSCC. Results Seventy‐six patients with dVIN at preoperative biopsy were included: at excisional specimens 44 were solitary dVIN and 32 were dVIN‐VSCC. The absolute risk of VSCC development after solitary dVIN treatment was 43.2% with median time to to VSCC diagnosis of 25.4 months (range 3.5–128.0 months). VSCC recurrence absolute risk in treated dVIN‐VSCC patients was 31.3% with median time to VSCC recurrence of 52.9 months (range 6.5–94.8 months). At uni‐ and multivariate regression analyses, only compliant topical ultrapotent corticosteroid treatment after solitary dVIN excision showed an ability to prevent VSCC development. No protective effect by corticosteroid treatment was shown for VSCC recurrence in dVIN‐VSCC patients. Smoking was associated with higher cancer recurrence risk in dVIN‐VSCC patients on both uni‐ and multivariate regression analyses. Conclusions Patients with dVIN have a high risk of developing both primary and recurring VSCC. Early recognition, long‐term follow up, and compliant ultrapotent topical corticosteroid treatment are recommended.https://doi.org/10.1111/aogs.14814differentiated vulvar intraepithelial neoplasiaoncologytopical corticosteroid therapyvulvar cancervulvar intraepithelial neoplasia |
| spellingShingle | Niccolò Gallio Mario Preti Ronald W. Jones Fulvio Borella Linn Woelber Luca Bertero Sara Urru Leonardo Micheletti Federica Zamagni Federica Bevilacqua Pierluigi Tondo Benedetta Pollano Paola Cassoni Chiara Benedetto Differentiated vulvar intraepithelial neoplasia long‐term follow up and prognostic factors: An analysis of a large historical cohort Acta Obstetricia et Gynecologica Scandinavica differentiated vulvar intraepithelial neoplasia oncology topical corticosteroid therapy vulvar cancer vulvar intraepithelial neoplasia |
| title | Differentiated vulvar intraepithelial neoplasia long‐term follow up and prognostic factors: An analysis of a large historical cohort |
| title_full | Differentiated vulvar intraepithelial neoplasia long‐term follow up and prognostic factors: An analysis of a large historical cohort |
| title_fullStr | Differentiated vulvar intraepithelial neoplasia long‐term follow up and prognostic factors: An analysis of a large historical cohort |
| title_full_unstemmed | Differentiated vulvar intraepithelial neoplasia long‐term follow up and prognostic factors: An analysis of a large historical cohort |
| title_short | Differentiated vulvar intraepithelial neoplasia long‐term follow up and prognostic factors: An analysis of a large historical cohort |
| title_sort | differentiated vulvar intraepithelial neoplasia long term follow up and prognostic factors an analysis of a large historical cohort |
| topic | differentiated vulvar intraepithelial neoplasia oncology topical corticosteroid therapy vulvar cancer vulvar intraepithelial neoplasia |
| url | https://doi.org/10.1111/aogs.14814 |
| work_keys_str_mv | AT niccologallio differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT mariopreti differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT ronaldwjones differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT fulvioborella differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT linnwoelber differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT lucabertero differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT saraurru differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT leonardomicheletti differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT federicazamagni differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT federicabevilacqua differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT pierluigitondo differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT benedettapollano differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT paolacassoni differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort AT chiarabenedetto differentiatedvulvarintraepithelialneoplasialongtermfollowupandprognosticfactorsananalysisofalargehistoricalcohort |