title: Clinical characteristics associated with development of recurrence and progression in usual-type vulvar intraepithelial neoplasia.
abstract: OBJECTIVE
  To identify clinical characteristics associated with recurrence and progression in patients with usual vulvar intraepithelial neoplasia (uVIN), which may function as prognostic factors and aid in the treatment of patients with human papillomavirus (HPV)-related disease of the genital tract.
  
  
  METHODS
  A retrospective chart review was performed in 73 patients with uVIN treated at the Leiden University Medical Center between 1990 and 2012. All medical records were reviewed for demographics, treatment type, pathology reports, and recurrence and progression rates.
  
  
  RESULTS
  The mean age of diagnosis was 43 years, and uVIN was symptomatic in 60.1% of the patients. The median follow-up time was 49 months. High-risk HPV was found in 86.3% of the patients. Smoking was reported in 76.8% of the patients. Eleven of 73 patients were immune compromised. Multicentric HPV-related disease of the cervix or vagina was reported in 75.3% of the patients. Recurrences were diagnosed in 50.7% of the patients after first treatment type that consisted of excision (45.2%), laser (34.2%), imiquimod (8.2%), and combination of excision and laser (12.3%). Higher recurrence rates were only correlated with multifocality of uVIN lesions. Excision, imiquimod therapy, and unifocal lesions showed an increased recurrence-free survival. Human papillomavirus type, smoking, multicentric disease, use of topical steroids, and positive surgical borders were not related to a shorter recurrence-free survival. Progression into vulvar carcinoma occurred in 11 (15.1%) of the patients, 4 of whom were immune compromised. These patients showed a shorter progression-free survival of 54 versus 71.5 months.
  
  
  CONCLUSIONS
  There are no clinical characteristics that form prognostic factors in uVIN, except for multifocality of lesions, which is correlated with a higher recurrence rate. Furthermore, progression of uVIN to carcinoma was accelerated and increased in immune-compromised patients, suggesting that studies of local immunity in uVIN may reveal potentialprognostic factors and aid in the development of new treatment modalities.
authors.affiliation: *Departments of Gynecology, †Pathology, ‡Medical Statistics, and §Clinical Oncology, Leiden University Medical Center, Leiden, TheNetherlands.
authors.forename: Edith M G
authors.initials: EM
authors.lastname: van Esch
authors.forename: Maija C I
authors.initials: MC
authors.lastname: Dam
authors.forename: Michelle E M
authors.initials: ME
authors.lastname: Osse
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.forename: Baptist J B M Z
authors.initials: BJ
authors.lastname: Trimbos
authors.forename: Gertjan
authors.initials: G
authors.lastname: Fleuren
authors.forename: Sjoerd H
authors.initials: SH
authors.lastname: van der Burg
authors.forename: Mariëtte I E
authors.initials: MI
authors.lastname: van Poelgeest
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D014846:Vulvar Neoplasms / Q000453:epidemiology*; D055815:Young Adult