J Gynecol Oncol.  2013 Jul;24(3):236-241. 10.3802/jgo.2013.24.3.236.

Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia

• Fehr MK
• Baumann M
• Mueller M
• Fink D
• Heinzl S
• Imesch P
• Dedes K

• KMID: 2288530
• DOI: http://doi.org/10.3802/jgo.2013.24.3.236

Abstract

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.

Keyword

Cancer; Intraepithelial neoplasia; Laser evaporation; Vagina; Vulva

MeSH Terms

Biopsy
Colposcopy
Disease Progression
Electronics
Electrons
Female
Follow-Up Studies
Humans
Immunosuppression
Logistic Models
Multivariate Analysis
Odds Ratio
Recurrence
Risk Factors
Smoke
Smoking
Smoking Cessation
Vagina
Vulva
Smoke

Figure

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  Fig. 1 Recurrence-free survival analysis of vulvovaginal intraepithelial neoplasia by initial treatment modality of either laser evaporation or surgical excision.

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  Fig. 2 Years to invasive disease after first treatment for intraepithelial neoplasia (n=24).

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