| Objective: To analyze the clinical manifestations and prognostic elements of different typology of vulvar carcinoma and explore the risk factors of vulvar cancer.Method: From June 2008 to June 2016,we analyze 165 patients with vulvar carcinoma from the Affiliated Hospital of Qingdao University retrospectively.On the basis of the etiology,they were divided into four parts,and we study their clinical factors.Compare and analyze the age,menopausal status,production time,autoimmune diseases,BMI,clinical symptoms(itching and pain,ulcer and erosion,vulvar neoplasm,no specific symptoms),tumor site(lateral lesion,midline lesion),postoperative pathology(tumor size,invasion depth,neoplasms histologic type,different extent of tumor differentiation,lymph node metastasis,neoplasm staging)of the four groups.And study the influence of etiology,age,tumor site,neoplasms histologic type,tumor size,invasion depth,vascular invasion,different extent of tumor differentiation,neoplasm staging、lymph node metastasis and different therapy method on prognosis of vulvar cancer.Kaplan-Meier method could be used to analyze the survival rate between different groups.So we used Bonferroni to put right the pairable comparison of clinical factors between the patients with vulvar dystrophic disease and the sicks with HPV infection.Chi square test could be used to study enumeration data.Then we used COX regression model for the multivariate analysis of the patients,so we can explore the prognostic features of vulvar carcinoma.Result: 1.The age,predilection site,clinical manifestation,autoimmune diseases,depth of the tumor infiltration,could be statistically meaningful between different groups of patients who with HPV or dystrophic disease on the vulva.For instance the patients with dystrophic disease on the vulva,aged ≥50 years old could take up 65.67%,and 68.66% had autoimmune disease,lateral lesion take up about 62.69%,the depth of the tumor infiltration >1mm account for 58.21%,the five-year survival rate could be 55.20%,and the prognosis of the patients is worse.For instance the patients with HPV infection,38.20% of the patients had no clinical symptoms obviously.aged <50 years old account for 57.14%,40.82% also had autoimmune disease,midline lesion account for 63.27%,the infiltration depth ≤1mm account for 65.31%.Five-year survival rate is 67.30%,which is better than others.2.In this study,19 of the 165 patients died of vulvar cancer,43 cases had recurrent or distant metastasis(of which 4 patients eventually died of vulvar cancer),and 146 cases of the study were still being alive by the end of follow-up.3.The factors influencing the prognosis of vulva cancer by univariate analysis including etiology,tumor site,associated autoimmune diseases,BMI,tumor type,depth of tumor invasion,lymph gland metastasis,tumor staging and different treatment.4.The prognostic features which is independent including: autoimmune disease、depth of infiltration、lymph gland metastasis.The 5 years survival rate of someone who had autoimmune disease,depth of infiltration more than 1mm,lymph gland metastasis could be 49.4%,45.1%,37.0%(P<0.05).Conclusion: 1.The clinical features and prognostic factors of different types of vulvar cancer could be different,there need more respective treatment.2.The prognosis of vulvar cancer combined with HPV infection is better,but some patients have no obvious conscious symptoms.So there need careful and comprehensive gynecological examination or colposcopy to improve the diagnosis rate in the early stage.However,patients with vulvar cancer combined with vulvar nutritional disorders have a high incidence of autoimmune diseases and a poor prognosis.We should give more attention to the patients who had autoimmune disease.Patients with autoimmune diseases need more positive treatment to improve the prognosis.3.The independent risk factors affecting the prognosis of vulvar cancer could be autoimmune diseases,depth of tumor invasion and lymph node metastasis. |
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