FIGO staging for carcinoma of the vulva: 2021 revision

Abstract

To revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic Oncology reviewed the recent literature to gain an insight into the impact of the 2009 vulvar cancer staging revision. The Committee resolved to revise the staging with a goal of simplification and actively collaborated with the United States National Cancer Database to analyze prospectively collected data on carcinoma of the vulva. Many tumor characteristics were collected for all stages of vulvar cancer treated between 2010 and 2017. Statistical analysis was performed with SAS software. Overall survival was estimated based on tumor characteristics. Log-rank and Wilcoxon tests were used to analyze overall survival similarities between and within groups of tumor characteristics. Characteristics with similar survivals were then grouped into the same stages and substages. Kaplan-Meier overall survival curves were generated for the resulting stages and substages. There were 12 063 cases with available data. The resulting new staging for carcinoma of the vulva has two substages in Stage I, no substage in Stage II, three substages in Stage III, and two substages in Stage IV. The Kaplan-Meier overall survival curves showed clear separation between stages and substages. The 2021 vulvar cancer staging is the first from the FIGO Committee for Gynecologic Oncology to be derived from data analyses. This revision has a new definition for depth of invasion, uses the same definition for lymph node metastases utilized in cervical cancer, and allows findings from cross-sectional imaging to be incorporated into vulvar cancer staging. The 2021 FIGO staging for carcinoma of the vulva is data-derived, validated, and much simpler than earlier revisions.

Cancer of the vulva: 2021 update

“…As a result, the Committee decided to update the staging for vulvar cancer. 39 NCDB vulvar cancer data collected over 7 years (2010–2017) was utilized in defining the new FIGO vulvar cancer staging (Table 2 ). This new staging is applicable to most malignancies arising from the vulva, except melanoma.…”

Management of Advanced Squamous Cell Carcinoma of the Vulva

“…The International Federation for Gynaecology and Obstetrics (FIGO) staging system for vulvar cancer has recently been updated (see Table 1 ) [ 4 ]. The term “Advanced Vulvar Cancer” may be considered to include very large or locally advanced tumours (stage I and II with tumours >4 cm in diameter); those with macroscopic nodal metastases (stage IIIB and IIIC); those that involve the urethra, bladder, anorectum, or pelvic bone (stage IVA); those for which adequate surgical excision requires sacrifice of the urethra or anus or an exenterative procedure; and those with distant metastases (stage IVB).…”

Human Papillomaviruses as Infectious Agents in Gynecological Cancers. Oncogenic Properties of Viral Proteins

“…A meta-analysis comprising 5015 cases of vulvar cancer and 2764 cases of VIN revealed that the prevalence of HPV in vulvar cancer was 39.7% and 76.3% in VIN lesions [226]. Basaloid and warty variants of VSCC are more common in younger women, are often associated with HPV DNA detection [227], and get similar risk factors as in cervical cancer. HPV prevalence in invasive basaloid and warty tumors is more frequent (69.4%) than in invasive VSCC types observed in elderly women (13.2%) [215].…”

“…Infection with HR-HPVs and viral DNA integration into the host cell genome seems to be related to the progression of VIN and its key steps are similar to those described in cervical cancer [229]. Recently, it has been recommended to document the HPV status of vulvar carcinomas (HPV-associated or HPV-independent) [227]. This is assessed by p16 block-type immunoreactivity and/or positive molecular testing for HPV.…”