Predictive factors for lymph node metastases in vulvar cancer. An analysis of the AGO-CaRE-1 multicenter study

Klapdor, Rüdiger; Hanker, Lars; Schmalfeldt, Barbara; Canzler, Ulrich; Fehm, Tanja; Luyten, Alexander; Hellriegel, Martin; Kosse, Jens; Heiss, C.; Hantschmann, Peer; Mallmann, Peter; Berno, Tamara; Pfisterer, Jacobus; Jückstöck, Julia; Hilpert, Felix; Gregorio, Nikolaus de; Hillemanns, Peter; Fürst, Sophie; Mahner, Sven

doi:10.1016/j.ygyno.2019.06.013

Cited by 17 publications

(12 citation statements)

References 17 publications

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“…We have data from the prospective GROINS-V-I study (groin recurrence rate 2.3%) and some smaller studies (groin recurrence rates 0-12%), which show, that SLND, if applied under restrictive conditions, leads to low groin recurrence rates, which are comparable to those of historic collectives of groin LND [5,7]. Similar results have been obtained by the subgroup analysis of the large retrospective multicenter AGO-CaRE-1 study [11]. According to the meta-analysis by Covens et al the isolated groin recurrence rate of SLND (3.4%, 95% CI 1.8-5.4%) and LND (1.4%, 95% CI 0.4-2.9%) did not differ significantly [7].…”

Section: Discussionsupporting

confidence: 75%

Sentinel lymph node biopsy in vulvar cancer: status, level of knowledge, and counseling in outpatient setting

Röttger

Hertel

Kaukemüller

et al. 2020

Arch Gynecol Obstet

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Purpose Evaluating the counseling of patients with vulvar cancer in outpatient setting regarding the application of sentinel lymph node dissection (SLND), the selection of hospitals for further treatment, and level of knowledge. Methods A questionnaire containing 29 questions about SLND in vulvar cancer was sent to gynecologists in Lower Saxony. The questionnaire contained multiple choice questions and open questions. The study was approved by the local ethics committee. Results The median age of the 86 respondents was 54 (26-66) years. Most participants (83.1%) reported to only treat one to five patients with vulvar cancer per year. Interestingly, 70.5% of the gynecologists send their patients to university hospitals and 64.1% to hospitals offering maximum care, respectively. Of all, 32.7% replied that SLND was performed rarely or never in their patients. The gynecologists answered that only 36.7% of the patients are well informed about advantages and possible disadvantages of SLND. Most (84%) felt responsible to counsel patients on treatment decisions independently from or additionally to the hospital. Of all, 72% replied that they are not completely sure about the exact recurrence rates after SLND. Of notice, 66% believe that SLND for vulvar cancer is safe if applied in specialized centers and 92% stated that focusing treatment on specialized centers is required for best results. Conclusion SLND for vulvar cancer is widely accepted and regularly recommended among gynecologists. Outpatient doctors report to send most patients to specialized centers. However, it appears that patients remain uninformed after counseling in the clinics and that there is a lack of detailed knowledge about risks and complication rates of groin treatment in the outpatient setting.

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Section: Discussionsupporting

confidence: 75%

Sentinel lymph node biopsy in vulvar cancer: status, level of knowledge, and counseling in outpatient setting

Röttger

Hertel

Kaukemüller

et al. 2020

Arch Gynecol Obstet

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“…[1][2][3][4][5][6][7][8] This is due to the fact that when recurrent groin metastasis occurs, the survival rates of these patients decrease signi cantly. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][30][31][32][33] The long-term follow-up of GROINSS-V showed that the 10-year disease-speci c survival rates in the cases of local recurrence was reduced from 90.4% to 68.7% and in patients with positive SLNB from 77.7% to 44.6%. 10 A German study of Woelber et al 7 , showed in none of the cases of primary VC with positive unilateral SLN contralateral positive LN in consecutive bilateral IFL (0/28 cases, 0%).…”

Section: Discussionmentioning

confidence: 99%

The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

Winarno

Mondal

Martignoni

et al. 2021

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Background: Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed (Woelber et al. 0% (p=0/28) and Nica et al. 5.3% (p=1/19)). Methods: A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results: 22.2% of women (n=4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p=0.0038). Conclusion: Current guideline for bilateral IFL should remain as the standard management. Therefore, this depth may be taken into account as an indication for bilateral IFL. The management of VC and SLNB should be performed in a high volume center with an experienced team in marking SLN and performing the adequate surgical procedure. Well conducted counseling of the patients outlining advantages but also potential oncological risks of this technique especially concerning rate of groin recurrence is critical.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, the current recommendation is to use SLNB only for tumors less than 4 cm of diameter. 19 Many studies show that the amount of groin LN metastasis is a signi cant negative predictor for survival. 20,21 Recurrences of metastatic LN in the groin are associated with high mortality rates.…”

Section: Following the Publication Of Groningen International Study Omentioning

confidence: 99%

The potential of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

Winarno

Mondal

Martignoni

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed (Woelber et al. 0% (p=0/28) and Nica et al. 5.3% (p=1/19)). Methods: A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results, discussion and conclusion: Current guideline for bilateral IFL should remain as the standard management as 22.2% of women (n=4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p=0.0038). Therefore, this depth may be taken into account as an indication for bilateral IFL.

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Predictive factors for lymph node metastases in vulvar cancer. An analysis of the AGO-CaRE-1 multicenter study

Cited by 17 publications

References 17 publications

Sentinel lymph node biopsy in vulvar cancer: status, level of knowledge, and counseling in outpatient setting

Sentinel lymph node biopsy in vulvar cancer: status, level of knowledge, and counseling in outpatient setting

The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

The potential of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

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