Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia

Abstract

ObjectiveThe 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.MethodsFour 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).ResultsOf 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.ConclusionLaser 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.

Vulvar intraepithelial neoplasia

“…VIN has a high risk of recurrence, usually occurring within 3 years of primary treatment [16,[20][21][22]. Our overall recurrence rate was similar to that reported in the literature and proved to be significantly higher for the HIV-positive group [16,23].…”

“…Four of these cases were HIV positive (36.4%). All women were included in this analysis because progression to carcinoma occurred at least 12 months after primary treatment which would suggest that these cases are unlikely to be related to undiagnosed occult carcinomas at the time of biopsy [5,22]. Laser ablation is a good alternative for young women with small multifocal lesions and was one of the preferred treatment methods for the HIV-positive group in our study.…”

Clinical presentation, treatment and outcome of vaginal intraepithelial neoplasia

“…In this study, 6 % of the included women had or developed vaginal cancer, which is in the range of other reports [8][9][10]. All of these cases were HR-HPV positive, all primarily had VAIN grade 3.…”

“…Other studies showed similar [8] or slightly lower values [15]. A large study that evaluated 411 women with high-grade VIN and VAIN found recurrence after treatment with CO 2 laser evaporation or surgical excision in almost 30 % [9]. In extensive cases of VAIN with multiple pretreatments laser-skinning colpectomy can be a feasible option with cure rates of almost 90 % reported [16].…”

Recurrence of vulval intraepithelial neoplasia following treatment with cidofovir or imiquimod: results from a multicentre, randomised, phase II trial (RT3VIN)

“…Rates for progression to invasive disease are difficult to estimate, as most women undergo surgery to remove the disease, but may be up to 5% per year, or 1–2% with surgery . Surgery is currently the standard treatment, but may be associated with significant morbidity and recurrence rates are high (reported at 30–56%), meaning that multiple surgeries are often required, which can cause significant physical and psychosexual morbidity. Alternative treatments are being sought.…”