Perineural Invasion in Vulvar Squamous-Cell Carcinoma Is an Independent Risk Factor for Cancer-Specific Survival, but Not for Locoregional Recurrence: Results from a Single Tertiary Referral Center

Abstract

The aims of this study were to assess the prevalence of perineural invasion (PNI) in vulvar squamous cell carcinoma (VSCC) and its prognostic role in locoregional recurrence (LRR) and cancer-specific survival (CSS). We performed a retrospective analysis of 223 consecutive stage IB–IIIC surgically treated VSCCs at S. Anna Hospital, University of Turin, from 2000 to 2019. We identified 133/223 (59.6%) patients with PNI-positive VSCCs. PNI was associated with aggressive biological features (i.e., advanced FIGO stage, larger tumor diameter, greater depth of invasion, a higher number of metastatic lymph nodes, and lymphovascular invasion) and shorter 5-year CSS (78% vs. 90%, log-rank p = 0.02) compared with PNI-negative VSCCs. Multivariate analysis showed that PNI (HR 2.99 CI 95% 1.17–7.63; p = 0.02) and the presence of tumor cells on pathological surgical margins (HR 3.13 CI 95% 1.37–7.13; p = 0.007) are independent prognostic factors for CSS. PNI does not appear to be related to LRR, but is an independent prognostic factor for worse survival outcomes. Future studies are necessary to explore the possible value of PNI in tailoring the choice of adjuvant treatment.

A Nomogram to Predict Survival in Patients With Locoregional Recurrent Nasopharyngeal Carcinoma Receiving Comprehensive Treatment

“…According to the latest studies, ALB is strongly associated with all-cause mortality, including cancer, cardiovascular diseases, and respiratory diseases, and lower ALB is associated with an increased risk of death ( 38 – 42 ). This is further confirmed in all cancer types, The studies in cervical carcinoma and vulvar squamous cell carcinoma had proved the value of nutritional indicators as independent risk factors ( 31 , 43 ). And ALB reduction has been independently shown to be closely related to precachexia/cachexia body composition, which indicated a worse prognosis and higher mortality ( 44 – 46 ).…”

Based on the surveillance, epidemiology, and end results programme, to develop and validate nomograms for predicting overall survival and cancer-specific survival in geriatric patients with vulvar squamous cell carcinoma

“…The median age of vulvar cancer diagnosis tends to be relatively high, mainly because older women are more susceptible to underlying health conditions that can eventually lead to cancer-related deaths unrelated to vulvar cancer itself. However, in our review of relevant literature regarding non-specific causes of death in vulvar cancer [16,18,24], we found a lack of nomogram-based predictions specifically designed for nonspecific mortality in elderly women with VSCC. Therefore, the primary goal of this research was to identify independent prognostic factors for elderly VSCC patients using the SEER database and to develop and validate prediction models for predicting their cancer-specific survival (CSS) and OS for establishing a solid foundation for clinical diagnosis and treatment practices and offering a valuable reference for healthcare professionals.…”

Therapeutic Approaches to Vulvar Cancer: A Review of Literature

“…Relapse is diagnosed between 12 and 37% of VC patients, most of whom recurs within 2 years of primary treat-ment [40]. Risk factors that increase recurrence rates include advanced age, large size of the primary tumor, its wide deep-extension, lymph node positivity, presence of lymph-vascular space invasion (LVSI), excision with nonideal margins, multifocality and persistence of precancerous lesions [41][42][43][44]. Localized recurrence is 20-23% and can be treated with surgery and the excision extent depends on tumor's size [23].…”