Dokument: Vulvakarzinom im Wandel der Zeit
| Titel: | Vulvakarzinom im Wandel der Zeit | |||||||
| Weiterer Titel: | Vulvar squamous cell carinoma - changes in time | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=54667 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20201111-110854-5 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Heinevetter, Kim Viviane [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Hampl, Monika [Gutachter] PD Dr. med. Reifenberger, Julia [Gutachter] | |||||||
| Stichwörter: | Vulvakarzinom, vulvar squamous cell carcinoma, Vulva Ca | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Zusammenfassung
Einleitung: Die Inzidenz des Vulvakarzinoms ist steigend, wobei der größte Anstieg bei Frauen im 50.-60.LJ zu verzeichnen ist und mit einer Abnahme des mittleren Erkrankungsalters einhergeht. Plattenepithelkarzinome der Vulva (VSCC) treten am häufigsten in der vorderen Kommissur der Vulva auf. Man differenziert in HPV-abhängige und -unabhängige Formen. HPV-abhängige VSCC entstehen eher bei jüngeren Frauen, verhornen nicht und gehen mit einer besseren Prognose einher. Lokoregionale operative Therapiemethoden sind weniger radikal geworden, während sich bei deutlich verbesserter Lebensqualität statistisch kaum erhöhte Rezidivraten zeigen. Zielsetzung: Ziel dieser Studie war es im Zeitintervall 2004-2014 Veränderungen hinsichtlich Inzidenz, Epidemiologie, Alter, Diagnostik, Therapie sowie postoperativer Komplikationen des VSCC in der UFK in Düsseldorf zu analysieren. Material und Methoden: In dieser klinisch-retrospektiven Studie wurden bei 314 Patientinnen mit VSCC der UFK Düsseldorf mittels Aktenrecherche oben genannte Parameter erhoben. Zwei Zeitintervalle, 2004-2009 und 2010-2014, wurden miteinander statistisch mit χ²- und T-Test in Bezug auf (signifikante) Unterschiede verglichen. Ergebnisse: Es zeigte sich ein Anstieg der Fallzahlen um das 2,5-fache zwischen 2004-2014, wobei das Alter bei Ersterkrankung stabil war. Im Vergleich zu den Altersangaben des RKI (72 Jahre mittleres Erkrankungsalter) waren unsere Frauen deutlich jünger (58 Jahre). 99% der Karzinome waren VSCC, davon 85% keratinisierend und 14% nicht-verhornend. In klinisch HPV-verdächtigen VSCC konnte in 95% der Fälle HPV-DNA nachgewiesen werden. Es zeigte sich eine Erhöhung der mittleren Infiltrationstiefe um 2 mm, während die häufigste Lokalisation mit 73% die vordere Kommissur darstellt. Die Lokalexzision des Tumors hat die radikale Vulvektomie (VE) als zweithäufigste Operationstechnik nach der partiellen VE abgelöst. Sentinel- Lymphonodektomien (SNLE) wurden 40% häufiger durchgeführt, wohingegen die inguinofemoralen Lymphknotendissektionen (IFLND) um 56% zurückgingen. Postoperative Beschwerden nahmen um 20% ab. Diskussion Insgesamt zeigen sich steigende Fallzahlen des VSCC. Die im klinischen Alltag beobachtete Zunahme an jungen Frauen mit Vulvakarzinom hat sich mit dem Alter bei Erstdiagnose im gesamten Beobachtungszeitraum in unserem Zentrum bestätigt. Ob der Inzidenzanstieg durch einen Anstieg HPVabhängiger VSCC bedingt ist, lässt sich aus unseren retrospektiven Daten nicht eruieren und kann nur über eine Testung auf HPV-DNA und Surrogat-Marker im Tumor erhoben werden. Dies könnte zu einer gezielten Therapieplanung auch bei dieser Tumorentität (targeted therapy) beitragen. Zukünftig ist ein Abfall der HPV-Inzidenz durch die Vakzinierung zu erwarten. Weniger radikale Operationsverfahren gehen mit unveränderter Rezidivrate und einer besseren Lebensqualität einher und sollten weiter vermehrt eingesetzt werden.Abstract Introduction: The incidence of vulvar squamous cell carcinoma increased during the last decades, especially in women aged 50-60, while the age of disease onset decreased. The area between urethra and clitoris is the most common localisation of VSCC. There are HPV associated and HPV independent forms of vulvar cancer. HPV associated VSCC are most likely diagnosed in younger women. They do not keratinize and go along with a better prognosis. Local operation techniques have become less radical while recurrence rates barely changed. Aim: Changes concerning incidence, age of onset, diagnostics, therapy and complications during the years 2004-2014 in patients treated at the Department of Gynecology and Obstetrics of the University Hospital of Düsseldorf were evaluated. Methods: This is a retrospective clinical study including data of patients treated with VSCC at the University Hospital of Düsseldorf during 2004-2014. Patients have been divided in two time periods, 2004-2009 and 2010-2014, regarding year of diagnosis. Both groups were analysed and compared with statistic tests (χ²- und T-Test) to evaluate possible significant effects. Results: The number of VSCC rose about 2.5 times during the time period 2004-2014. Age of onset did not change. In comparison to mean age of onset of VSCC in Germany (mean age 72) our patients were younger (mean age 58). 99% of all the cases of vulvar cancer were VSCC while 85% of them were keratinized tumors. When HPV-associated VSCC was clinically suspected, HPV-DNA was detected in 95% of the cases. Mean tumor infiltration increased by 2mm in average. The most common localisation was the area between clitoris and urethra (72%). Local resection of the tumor is now the second most common type of surgery performed instead of total vulvectomy. The most common type of operation performed is partial vulvectomy. While use of sentinel node biopsies increased about 40% the number of performed total inguinal lymphonodectomies decreased about 56%. Percentage of surgical complications decreased by 20%. Discussion: Overall there is an increase of VSCC. The increase of younger women diagnosed with VSCC - as observed in clinical practice - has been verified by our data. Retrospectively it is not possible to differentiate if the rise of incidence is caused by HPV-associated VSCC or not. To find an answer, all VSCC have to be tested for HPV-DNA and surrogate markers. In the future this could also lead to a more specific cancer therapy (targeted therapy). Due to HPV-vaccination a decrease of vaccine type HPV-incidence is likely. Less radical operation techniques have no influence on the recurrence rate but at the same time improve quality of life of the women and therefore should continue to be used more frequently. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 11.11.2020 | |||||||
| Dateien geändert am: | 11.11.2020 | |||||||
| Promotionsantrag am: | 10.08.0020 | |||||||
| Datum der Promotion: | 03.11.2020 |
