Surgical Treatment of Paget Disease of the Vulva

Prognostic Significance of Stromal Invasion and Surgical Margin Status

Francesco Sopracordevole, Jacopo Di Giuseppe, Giovanni de Piero, Vincenzo Canzonieri, Monica Buttignol, Giorgio Giorda, Andrea Ciavattini

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVE: The aim of the study was to evaluate the risk of recurrence according to the surgical margin status and the presence of invasion or of superficially invasive carcinoma in patients with extramammary Paget disease (EMPD) of the vulva, who underwent elective surgical treatment. MATERIALS AND METHODS: We performed a retrospective analysis of 27 patients with first diagnosis of extramammary Paget disease of the vulva, who underwent primary and elective surgical treatment from January 1989 to December 2014. A p value of less than .05 was considered statistically significant. Multivariable logistic regression was performed to adjust for confounding factors. RESULTS: We observed invasive disease in 11 cases, with microinvasion in 8 of them. A positive surgical margin was found in 10 patients. During a median follow-up period of 79.5 months, 8 patients (29.6%) showed a first recurrence after a median (range) time of 4.9(2.3–7.1) years. No significant differences were observed between patients with recurrence and patients without recurrence with respect to age, number of vulvar sectors involved, bilaterality and multifocality, presence of invasion or microinvasion, and surgical margin status. However, during the follow-up period, the presence of invasion was higher (67% vs 41%) in patients with recurrence compared with patients without recurrence. CONCLUSIONS: The rate of recurrence of the disease after therapy is high. Patients should be subjected to a close and long-term follow-up to identify those who must undergo further treatment, especially if they presented with an invasive or even microinvasive disease. A free margin of no greater than 1 to 2 cm might be the most appropriate surgical choice.

Original languageEnglish
JournalJournal of Lower Genital Tract Disease
DOIs
Publication statusPublished - 2016

Fingerprint

Vulva
Recurrence
Extramammary Paget's Disease
Therapeutics
Margins of Excision
Logistic Models
Carcinoma

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

@article{432de7f9eec3463a8b7e6a28eca3e031,
title = "Surgical Treatment of Paget Disease of the Vulva: Prognostic Significance of Stromal Invasion and Surgical Margin Status",
abstract = "OBJECTIVE: The aim of the study was to evaluate the risk of recurrence according to the surgical margin status and the presence of invasion or of superficially invasive carcinoma in patients with extramammary Paget disease (EMPD) of the vulva, who underwent elective surgical treatment. MATERIALS AND METHODS: We performed a retrospective analysis of 27 patients with first diagnosis of extramammary Paget disease of the vulva, who underwent primary and elective surgical treatment from January 1989 to December 2014. A p value of less than .05 was considered statistically significant. Multivariable logistic regression was performed to adjust for confounding factors. RESULTS: We observed invasive disease in 11 cases, with microinvasion in 8 of them. A positive surgical margin was found in 10 patients. During a median follow-up period of 79.5 months, 8 patients (29.6{\%}) showed a first recurrence after a median (range) time of 4.9(2.3–7.1) years. No significant differences were observed between patients with recurrence and patients without recurrence with respect to age, number of vulvar sectors involved, bilaterality and multifocality, presence of invasion or microinvasion, and surgical margin status. However, during the follow-up period, the presence of invasion was higher (67{\%} vs 41{\%}) in patients with recurrence compared with patients without recurrence. CONCLUSIONS: The rate of recurrence of the disease after therapy is high. Patients should be subjected to a close and long-term follow-up to identify those who must undergo further treatment, especially if they presented with an invasive or even microinvasive disease. A free margin of no greater than 1 to 2 cm might be the most appropriate surgical choice.",
author = "Francesco Sopracordevole and {Di Giuseppe}, Jacopo and {de Piero}, Giovanni and Vincenzo Canzonieri and Monica Buttignol and Giorgio Giorda and Andrea Ciavattini",
year = "2016",
doi = "10.1097/LGT.0000000000000191",
language = "English",
journal = "Journal of Lower Genital Tract Disease",
issn = "1089-2591",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Surgical Treatment of Paget Disease of the Vulva

T2 - Prognostic Significance of Stromal Invasion and Surgical Margin Status

AU - Sopracordevole, Francesco

AU - Di Giuseppe, Jacopo

AU - de Piero, Giovanni

AU - Canzonieri, Vincenzo

AU - Buttignol, Monica

AU - Giorda, Giorgio

AU - Ciavattini, Andrea

PY - 2016

Y1 - 2016

N2 - OBJECTIVE: The aim of the study was to evaluate the risk of recurrence according to the surgical margin status and the presence of invasion or of superficially invasive carcinoma in patients with extramammary Paget disease (EMPD) of the vulva, who underwent elective surgical treatment. MATERIALS AND METHODS: We performed a retrospective analysis of 27 patients with first diagnosis of extramammary Paget disease of the vulva, who underwent primary and elective surgical treatment from January 1989 to December 2014. A p value of less than .05 was considered statistically significant. Multivariable logistic regression was performed to adjust for confounding factors. RESULTS: We observed invasive disease in 11 cases, with microinvasion in 8 of them. A positive surgical margin was found in 10 patients. During a median follow-up period of 79.5 months, 8 patients (29.6%) showed a first recurrence after a median (range) time of 4.9(2.3–7.1) years. No significant differences were observed between patients with recurrence and patients without recurrence with respect to age, number of vulvar sectors involved, bilaterality and multifocality, presence of invasion or microinvasion, and surgical margin status. However, during the follow-up period, the presence of invasion was higher (67% vs 41%) in patients with recurrence compared with patients without recurrence. CONCLUSIONS: The rate of recurrence of the disease after therapy is high. Patients should be subjected to a close and long-term follow-up to identify those who must undergo further treatment, especially if they presented with an invasive or even microinvasive disease. A free margin of no greater than 1 to 2 cm might be the most appropriate surgical choice.

AB - OBJECTIVE: The aim of the study was to evaluate the risk of recurrence according to the surgical margin status and the presence of invasion or of superficially invasive carcinoma in patients with extramammary Paget disease (EMPD) of the vulva, who underwent elective surgical treatment. MATERIALS AND METHODS: We performed a retrospective analysis of 27 patients with first diagnosis of extramammary Paget disease of the vulva, who underwent primary and elective surgical treatment from January 1989 to December 2014. A p value of less than .05 was considered statistically significant. Multivariable logistic regression was performed to adjust for confounding factors. RESULTS: We observed invasive disease in 11 cases, with microinvasion in 8 of them. A positive surgical margin was found in 10 patients. During a median follow-up period of 79.5 months, 8 patients (29.6%) showed a first recurrence after a median (range) time of 4.9(2.3–7.1) years. No significant differences were observed between patients with recurrence and patients without recurrence with respect to age, number of vulvar sectors involved, bilaterality and multifocality, presence of invasion or microinvasion, and surgical margin status. However, during the follow-up period, the presence of invasion was higher (67% vs 41%) in patients with recurrence compared with patients without recurrence. CONCLUSIONS: The rate of recurrence of the disease after therapy is high. Patients should be subjected to a close and long-term follow-up to identify those who must undergo further treatment, especially if they presented with an invasive or even microinvasive disease. A free margin of no greater than 1 to 2 cm might be the most appropriate surgical choice.

UR - http://www.scopus.com/inward/record.url?scp=84958260235&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958260235&partnerID=8YFLogxK

U2 - 10.1097/LGT.0000000000000191

DO - 10.1097/LGT.0000000000000191

M3 - Article

JO - Journal of Lower Genital Tract Disease

JF - Journal of Lower Genital Tract Disease

SN - 1089-2591

ER -