文章：

外阴癌患者管理：国际指南系统性比较（NCCN–ASCO–ESGO–BGCS–IGCS–FIGO–法国指南–RCOG）

Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN–ASCO–ESGO–BGCS–IGCS–FIGO–French Guidelines–RCOG)

原文发布日期：8 January 2025

DOI: 10.3390/cancers17020186

类型: Article

开放获取: 是

英文摘要：

Background: Vulvar carcinoma is an uncommon gynecological tumor primarily affecting older women. Its treatment significantly impacts the quality of life and, not least, aesthetics because of the mutilating surgery it requires. Objectives: The management requires a multidisciplinary team of specialists who know how to care for the patient in her entirety, not neglecting psychological aspects and reconstructive surgery. How do the guidelines address multidisciplinarity, team surgical management, passing through preoperative diagnosis, and follow-up in such a challenging rare tumor to treat? Methods: To answer these questions, we compared the main scientific recommendations to identify similarities and differences in diagnostic and therapeutic management to provide an overview of the gaps that there are currently in European and American international recommendations in providing management guidance in a cancer that is both among the rarest and most difficult to manage. In this way, we aim to encourage an update in practices based on the latest scientific evidence. Results: A review of various international guidelines, some dating back to 2014, shows significant variation in approaches, ranging from initial diagnostic procedures to managing relapses. The most recent guidelines also lacked references to the latest literature, indicating that more robust scientific evidence is needed before new treatments, such as electrochemotherapy for palliation and reconstructive surgery post exenteration, can be widely adopted. Conclusions: From the systematic comparison of the main international guidelines, a strong heterogeneity emerged in the diagnostic and therapeutic recommendations as well as for the multidisciplinary approach that today is essential. Our work certainly stimulated an update of the main guidelines.

摘要翻译： 

背景：外阴癌是一种罕见的妇科肿瘤，主要影响老年女性。由于其治疗通常需要破坏性手术，因此对患者的生活质量及美观性产生显著影响。 目的：该疾病的管理需要一个多学科专家团队，这些专家需懂得如何全面照护患者，不忽视心理层面及重建手术的重要性。针对这种治疗极具挑战性的罕见肿瘤，现有指南如何应对多学科协作、团队手术管理、术前诊断及随访等环节？ 方法：为回答这些问题，我们比较了主要科学建议，以识别诊断和治疗管理中的异同点，从而概述当前欧美国际指南在提供这种既罕见又难治的癌症管理指导方面存在的不足。通过这种方式，我们旨在推动基于最新科学证据的实践更新。 结果：对多项国际指南（部分可追溯至2014年）的回顾显示，从初始诊断流程到复发管理，各指南的处理方式存在显著差异。最新指南也缺乏对近期文献的引用，这表明在广泛采用新疗法（如用于姑息治疗的电化学疗法和脏器切除术后重建手术）之前，需要更坚实的科学证据。 结论：通过对主要国际指南的系统比较，我们发现其在诊断和治疗建议以及当今不可或缺的多学科协作方面存在显著异质性。我们的工作无疑推动了主要指南的更新进程。

原文链接：

Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN–ASCO–ESGO–BGCS–IGCS–FIGO–French Guidelines–RCOG)