Predictive factors with reference to low-risk of metastases in squamous cell carcinoma in the vulvar region

Andreasson, Benny; Nyboe, Jørgen

doi:10.1016/0090-8258(85)90252-5

Cited by 24 publications

(9 citation statements)

References 19 publications

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“…Only a small number of studies have been published with multi variate analysis [1,10,[22][23][24][25][26][27][28].…”

mentioning

confidence: 99%

“…vulvectomy without groin dissection was only performed in patients with a weak general condition [4,10]. In recent years, a more individual treatment of vulva carcinoma with partial vulvectomy or wide excision with ipsi-or bilateral inguinal or inguinofemoral lymphadenectomy or triple incision was proposed [11][12][13][14][15][16][17], Pretreatment with chemotherapy or radiation as well as adjuvant radiothera py have been reported [18][19][20], As a new technique, treat ment with CO2 laser is also used [21].…”

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confidence: 99%

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A Multivariate Analysis of Clinical and Morphological Prognostic Factors in Squamous Cell Carcinoma of the Vulva

Smyczek-Gargya

Volz²,

Geppert³

et al. 1997

Gynecol Obstet Invest

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Clinical and histological data of 168 patients with squamous cell carcinoma of the vulva were analyzed with respect to survival. 151 patients underwent surgery, 12 patients were treated with primary radiation and in 5 patients no treatment was performed. Follow-up lasted from at least 2 up to 22 years’ posttreatment. In univariate analysis, the following factors were highly significant: presurgery lymph node status, tumor infiltration beyond the vulva, tumor grading, histological inguinal lymph node status, pre- and postsurgery tumor stage, depth of invasion and tumor diameter. In the multivariate analysis (Cox regression), the most powerful factors were shown to be histological inguinal lymph node status, tumor diameter and tumor grading. The multivariate logistic regression analysis worked out as main prognostic factors for metastases of inguinal lymph nodes: presurgery inguinal lymph node status, tumor size, depth of invasion and tumor grading. Based on these results, tumor biology seems to be the decisive factor concerning recurrence and survival. Therefore, we suggest a more conservative treatment of vulvar carcinoma. Patients with confined carcinoma to the vulva, with a tumor diameter up to 3 cm and without clinical suspected lymph nodes, should be treated by wide excision/partial vulvectomy with ipsilateral lymphadenectomy.

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“…Only a small number of studies have been published with multi variate analysis [1,10,[22][23][24][25][26][27][28].…”

mentioning

confidence: 99%

mentioning

confidence: 99%

A Multivariate Analysis of Clinical and Morphological Prognostic Factors in Squamous Cell Carcinoma of the Vulva

Smyczek-Gargya

Volz²,

Geppert³

et al. 1997

Gynecol Obstet Invest

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“…In the past, many studies on histopathologic parameters of the primary tumor have been performed in vulvar carcinoma with the aim to define a group with ''low risk on lymph node metastases.'' Initially, several authors considered, by analogy with cervical carcinoma, depth of invasion 5 mm as ''microinvasive,'' with an extremely low risk on inguinofemoral lymph node metastases, but several more recent studies showed that the percentage of patients with inguinofemoral lymph node metastases rises steadily with each millimeter of invasion (49)(50)(51)(52)(53)(54)(55)(56)(57) . See Table 4 for an overview of five studies, which registered the percentage of inguinofemoral lymph node metastases related to depth of invasion per millimeter in patients with T1 (2 cm) tumors (50,52,(55)(56)(57) .…”

Section: Histopathologic Parametersmentioning

confidence: 99%

“…The loss of Rb expression increased from FIGO stage I to IV, suggesting that Rb may play a role in tumor progression (81) . Another study showed progressive decrease of Rb2/p130 (a retinoblastoma-related protein) expression from non-neoplastic epithelial alterations through intraepithelial neoplasia to invasive vulvar (57) 122 Tumor site, depth of invasion, tumor size Boyce et al (56) 84 Clinical node status, depth of invasion, growth pattern Smyczek-Gargya et al (63) 168 Clinical node status, tumor size, depth of invasion, tumor grading carcinoma, suggesting a role for this tumor suppressor gene in vulvar carcinogenesis. There was no correlation between Rb2/p130 expression and the presence of lymph node metastases (82) .…”

Section: Cell Biologic Parametersmentioning

confidence: 99%

Prediction of lymph node metastases in vulvar cancer: a review

Oonk¹,

Hollema²,

Hullu³

et al. 2006

Int J Gynecol Cancer

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The aim of this study was to review the literature on currently available non- and minimally-invasive diagnostic methods and analysis of primary tumor characteristics for prediction of inguinofemoral lymph node metastases in patients with primary squamous cell carcinoma of the vulva. We used the English language literature in PubMed and reference lists from selected articles. Search terms included vulvar carcinoma, prognosis, lymph node metastases, ultrasound, computer tomography, magnetic resonance imaging, positron emission tomography, and sentinel lymph node. No study type restrictions were imposed. Currently no noninvasive imaging techniques exist that are able to predict lymph node metastases with a high enough negative predictive value. A depth of invasion < or =1 mm is the only histopathologic parameter that can exclude patients for complete inguinofemoral lymphadenectomy. No other clinicopathologic parameter allows exclusion of lymph node metastases with a high enough negative predictive value. The minimally invasive sentinel node procedure is a promising technique for selecting patients for complete lymphadenectomy, but its safety has not been proven yet.

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“…In a recent review [5], it was shown that currently available non-invasive diagnostic tests (palpation, ultrasound (with or without FNA cytology), CT, MRI, PET) are not able to exclude inguinofemoral lymph node metastases with a certainty that is high enough to safely omit complete inguinofemoral lymphadenectomy, while the safety of the sentinel node technique is currently being evaluated in phase II studies [6][7][8]. Studies on different histopathogical parameters of the primary vulvar tumor showed a very low (< 1%) risk for inguinofemoral metastases in tumors with a depth of invasion less than 1 mm [9][10][11][12][13]. No other 'classic' histopathological parameters are able to define comparable "low-risk groups" of patients with invasive squamous cell carcinoma of the vulva.…”

Section: Introductionmentioning

confidence: 99%

EGFR expression is associated with groin node metastases in vulvar cancer, but does not improve their prediction

Oonk

Bock²,

Veen

et al. 2007

Gynecologic Oncology

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Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. AbstractObjectives. High morbidity of elective inguinofemoral lymphadenectomy in early stage vulvar cancer patients urges the need for defining a group of low-risk patients in whom inguinofemoral lymphadenectomy can be safely omitted. Aim of the study was to evaluate whether in addition to 'classic' clinicopathological factors determination of EGFR expression in vulvar cancer can be helpful in defining such a 'low-risk' group.Methods. Formalin-fixed paraffin-embedded tumor tissue samples of 197 surgically treated T1/2 patients were collected in a Tissue Micro Array (TMA). On this TMA, immunohistochemistry for EGFR was performed. Logistic regression analyses were performed including histopathological characteristics with the presence of nodal metastases as outcome. A predictive model was constructed, and absolute risks were calculated.Results. EGFR expression was present in 68% of the vulvar tumors and related to the presence of lymph node metastases (OR 2.12, 95% CI 1.09-4.10). Our predictive model with only clinicopathological factors was able to define a group of patients with a likelihood of absence of lymph node metastases of 13% (95% CI 5-36), which could be decreased to 6% (95% CI 0-29) after inclusion of EGFR expression (p = 0.07).Conclusions. EGFR expression is present in the majority of vulvar tumors and is associated with groin node metastases in vulvar cancer. Current classic clinicopathological predictive factors for inguinofemoral lymph node metastases with or without EGFR analysis are not strong enough for identification of "sufficiently low" risk T1/2 vulvar cancer patients. Our predictive model approach however is excellent for evaluation of new cell biological parameters, associated with clinical outcome.

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Predictive factors with reference to low-risk of metastases in squamous cell carcinoma in the vulvar region

Cited by 24 publications

References 19 publications

A Multivariate Analysis of Clinical and Morphological Prognostic Factors in Squamous Cell Carcinoma of the Vulva

A Multivariate Analysis of Clinical and Morphological Prognostic Factors in Squamous Cell Carcinoma of the Vulva

Prediction of lymph node metastases in vulvar cancer: a review

EGFR expression is associated with groin node metastases in vulvar cancer, but does not improve their prediction

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