Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia

Objective. The best treatment modality and factors affecting recurrence amo ng women with vaginal intraepithelial neoplasia (VAIN) are yet to be determ ined. The aims of the current study were to describe the clinical features, results of treatment, and factors affecting recurrence among patients with VAIN. Methods. We conducted a retrospective review of 121 women with VAIN after c onfirming the histologic diagnosis. Patient demographics, clinical features , and results of therapy were recorded. Factors affecting recurrence were a ssessed using the odds ratio and the 95% confidence intervals among patient s who were followed up for 7 months or more and had at least one posttreatm ent Papanicolaou smear. Significant univariate odds ratios were assessed jo intly in a multivariate model with a stratified analysis. Results. The mean age of the patients was 35.0 (+/- 17), 41% of the patient s smoked, 39% had a history of human papillomavirus infection, 27% had hist ory of sexually transmitted diseases, 22% had history of surgery for cervic al intraepithelial neoplasia (CIN), and 23% had total hysterectomy. The upp er third of the vagina was the most common site of VAIN and 61% of the lesi ons were multifocal. Associated cervical and vulvar intraepithelial neoplas ia (VIN) were present in 65 and 10%, respectively. Recurrences of VAIN and progression to invasive vaginal cancer occurred in 33 and 2%, respectively. Recurrences following partial vaginectomy, laser, and 5-fluorouracil were 0, 38, and 59%, respectively (P = 0.0001). Multifocality and method of trea tment were significant independent predictors of VAIN recurrences (odds rat io 3.3, 95% CI 1.2, 9.2, P = 0.02, and 22.4, 95% CI 1.3, 393.6, P = 0.001, respectively), with no interaction, based on a stratified analysis. Conclusions. VAIN occurs most often among women with CIN or VIN, commonly i nvolves the upper third of the vagina, and is often multifocal. Partial vag inectomy provides the highest cure rate and multifocality is a risk factor for recurrence. (C) 2001 Academic Press.