Abstract：
OBJECTIVE: To evaluate the impact of high-potency topical steroid use on risk of recurrence of lichen sclerosus-associated vulvar cancer.
METHODS: This is a retrospective cohort study evaluating patients with lichen sclerosus (LS)- associated vulvar squamous cell cancer (VSCC). Demographic and clinical outcome data were compared between two comparison groups: patients who received steroids, mainly clobetasol, and patients who did not receive steroids following treatment of LS-related vulvar cancer. Categorical variables were compared using Fisher\'s exact test or chi-square test. Continuous variables were compared using a two-sided student\'s t-test. Time to recurrence (TTR) and overall survival (OS) were analyzed using Kaplan-Meier survival plot and compared using Mantel-Cox log rank test. Cox proportional hazard regression models were conducted to generate hazard ratios for both TTR and OS. A p value of <0.05 was considered statistically significant.
RESULTS: A total of 49 patients were included, with 36 patients receiving steroid treatment and 13 patients in the expectant management group. The median age of diagnosis was 68. The average BMI was 31.7 +/- 7.0. The median length of follow up was 41 months. The majority of patients were diagnosed with stage I VSCC. There was no difference in demographics or oncologic management of vulvar cancer between the two cohorts. Overall recurrence was decreased among patients who received steroid treatment when compared to patients who did not, 12 patients (33.3%) versus 9 patients (69.2%) respectively (p = 0.048).
CONCLUSIONS: High-potency topical steroid use following treatment of lichen sclerosus-associated vulvar squamous cell carcinoma is associated with decreased risk of recurrence and prolonged median time to recurrence.
METHODS: This is a retrospective cohort study evaluating patients with lichen sclerosus (LS)- associated vulvar squamous cell cancer (VSCC). Demographic and clinical outcome data were compared between two comparison groups: patients who received steroids, mainly clobetasol, and patients who did not receive steroids following treatment of LS-related vulvar cancer. Categorical variables were compared using Fisher\'s exact test or chi-square test. Continuous variables were compared using a two-sided student\'s t-test. Time to recurrence (TTR) and overall survival (OS) were analyzed using Kaplan-Meier survival plot and compared using Mantel-Cox log rank test. Cox proportional hazard regression models were conducted to generate hazard ratios for both TTR and OS. A p value of <0.05 was considered statistically significant.
RESULTS: A total of 49 patients were included, with 36 patients receiving steroid treatment and 13 patients in the expectant management group. The median age of diagnosis was 68. The average BMI was 31.7 +/- 7.0. The median length of follow up was 41 months. The majority of patients were diagnosed with stage I VSCC. There was no difference in demographics or oncologic management of vulvar cancer between the two cohorts. Overall recurrence was decreased among patients who received steroid treatment when compared to patients who did not, 12 patients (33.3%) versus 9 patients (69.2%) respectively (p = 0.048).
CONCLUSIONS: High-potency topical steroid use following treatment of lichen sclerosus-associated vulvar squamous cell carcinoma is associated with decreased risk of recurrence and prolonged median time to recurrence.
摘要：
目的：评估高效局部使用类固醇对苔藓硬化相关外阴癌复发风险的影响。
方法：这是一项回顾性队列研究，评估患有硬化苔藓（LS）相关外阴鳞状细胞癌（VSCC）的患者。人口统计学和临床结果数据在两个比较组之间进行了比较：接受类固醇治疗的患者，主要是氯倍他索,以及LS相关外阴癌治疗后未接受类固醇治疗的患者。使用Fisher精确检验或卡方检验比较分类变量。使用双侧学生t检验比较连续变量。使用Kaplan-Meier生存图分析复发时间（TTR）和总生存期（OS），并使用Mantel-Cox对数秩检验进行比较。进行Cox比例风险回归模型以产生TTR和OS的风险比。<0.05的p值被认为是统计学上显著的。
结果：共纳入49例患者，36例患者接受类固醇治疗，13例患者为期待管理组。诊断年龄中位数为68岁。平均BMI为31.7+/-7.0。中位随访时间为41个月。大多数患者被诊断为I期VSCC。两组外阴癌的人口统计学或肿瘤学管理没有差异。与未接受类固醇治疗的患者相比，接受类固醇治疗的患者总体复发减少，12例患者（33.3％）与9例患者（69.2％）（p=0.048）。
结论：治疗硬化性苔藓相关的外阴鳞状细胞癌后高效局部使用类固醇与复发风险降低和中位复发时间延长相关。
方法：这是一项回顾性队列研究，评估患有硬化苔藓（LS）相关外阴鳞状细胞癌（VSCC）的患者。人口统计学和临床结果数据在两个比较组之间进行了比较：接受类固醇治疗的患者，主要是氯倍他索,以及LS相关外阴癌治疗后未接受类固醇治疗的患者。使用Fisher精确检验或卡方检验比较分类变量。使用双侧学生t检验比较连续变量。使用Kaplan-Meier生存图分析复发时间（TTR）和总生存期（OS），并使用Mantel-Cox对数秩检验进行比较。进行Cox比例风险回归模型以产生TTR和OS的风险比。<0.05的p值被认为是统计学上显著的。
结果：共纳入49例患者，36例患者接受类固醇治疗，13例患者为期待管理组。诊断年龄中位数为68岁。平均BMI为31.7+/-7.0。中位随访时间为41个月。大多数患者被诊断为I期VSCC。两组外阴癌的人口统计学或肿瘤学管理没有差异。与未接受类固醇治疗的患者相比，接受类固醇治疗的患者总体复发减少，12例患者（33.3％）与9例患者（69.2％）（p=0.048）。
结论：治疗硬化性苔藓相关的外阴鳞状细胞癌后高效局部使用类固醇与复发风险降低和中位复发时间延长相关。
