比较接受原发性放疗和手术治疗的女性阴道癌患者的生存情况和并发症。对Kaiser Permanente成员进行回顾性队列研究，纳入2008年至2018年间被诊断为阴道鳞状细胞癌（SCC）并接受原发性手术（PS only）、手术辅助放疗（PS + RT）或原发性放疗（PRT）的患者。主要观察指标为1年和3年总体生存率（OS）和无进展生存率（PFS）。多变量回归分析纠正了年龄、阶段、合并疾病和吸烟等因素。纳入了201名女性患者，其中114例为PS only（56.7%），36例为PS + RT（17.9%），51例为PRT（25.4%）。PS only患者的疾病较为早期。PS only组的1年和3年总体生存率为96.5%和82.6%，与PS + RT组的72.2%和48.3%，以及PRT组的72.6%和53.9%相比（p < 0.001）。在控制阶段和其他混杂因素后，死亡风险没有统计学差异（PRT vs PS only：aHR 1.35，95% CI 0.61-2.99；PS + RT vs PS only：aHR 1.28，95% CI 0.60-2.75；PS + RT vs PRT：aHR 0.95，CI 0.48-1.90）。年龄较大和Ⅲ期疾病是不良预后因素。PS + RT组的淋巴水肿风险增加（36.1% vs PS only的20.2%，以及PRT的9.8%，p = 0.011）。手术组的切口感染较为常见，而PRT组的住院再次和输血事件更为常见。在控制阶段的情况下，接受原发性放疗与手术治疗的女性阴道癌生存率无统计学差异。手术后辅助放疗的淋巴水肿发生率较高。原发性放疗可能是那些可能需要辅助治疗的女性患者的可接受替代方法。版权所有 © 2023 Elsevier Inc. 保留所有权利。

To compare survival and complications for women with vulvar cancer treated with primary radiation vs surgery.Retrospective cohort study of Kaiser Permanente members diagnosed with vulvar squamous cell carcinoma (SCC) between 2008 and 2018 and treated with primary surgery (PS only), surgery with adjuvant radiation (PS + RT), or primary radiation (PRT). Primary outcomes were 1- and 3-year overall (OS) and progression-free (PFS) survival. Multivariable regression adjusted for age, stage, comorbidities, and smoking.We included 201 women: 114 PS only (56.7%), 36 PS + RT (17.9%), and 51 PRT (25.4%). PS only patients had less advanced disease. Crude 1- and 3-year OS were 96.5% and 82.6% for PS only compared to 72.2% and 48.3% for PS + RT and 72.6% and 53.9% for PRT (p < 0.001). There were no statistical differences in hazard of death when controlling for stage and other covariates (PRT vs PS only: aHR 1.35, 95% CI 0.61-2.99; PS + RT vs PS only: aHR 1.28, 95% CI 0.60-2.75; PS + RT vs PRT: aHR 0.95, CI 0.48-1.90). Older age and stage III disease were poor prognostic factors. Risk of lymphedema was elevated with PS + RT (36.1% vs 20.2% for PS only and 9.8% for PRT, p = 0.011). Wound infection was more likely in surgical groups, whereas hospital readmission and blood transfusion were more common with PRT.Vulvar cancer survival was not statistically different among women treated with primary radiation compared to primary surgery when controlling for stage. Surgery followed by adjuvant radiation demonstrated elevated rates of lymphedema. Primary radiation therapy may be an acceptable alternative to primary surgery in women who are likely to need adjuvant therapy.Copyright © 2023 Elsevier Inc. All rights reserved.