Prognostic factors associated with local recurrence in squamous cell carcinoma of the vulva

Abstract

ObjectiveTo analyze the prognostic factors related to the recurrence rate of vulvar cancer.MethodsRetrospective study of 87 patients diagnosed of vulvar squamous cell carcinoma diagnosed at a tertiary hospital in Madrid between January 2000 and December 2010.ResultsThe pathological mean tumor size was 35.1±22.8 mm, with stromal invasion of 7.7±6.6 mm. The mean free margin after surgery was 16.8±10.5 mm. Among all patients, 31 (35.6%) presented local recurrence (mean time 10 months; range, 1 to 114 months) and 7 (8%) had distant metastases (mean time, 5 months; range, 1 to 114 months). We found significant differences in the mean tumor size between patients who presented a relapse and those who did not (37.6±21.3 mm vs. 28.9±12.1 mm; p=0.05). Patients with free margins equal or less than 8 mm presented a relapse rate of 52.6% vs. 43.5% of those with free margin greater than 8 mm (p=0.50). However, with a cut-off of 15 mm, we observed a local recurrence rate of 55.6% vs. 34.5%, respectively (p=0.09). When the stromal invasion cut-off was >4 mm, local recurrence rate increased up to 52.9% compared to 37.5% when the stromal invasion was ≤4 mm (p=0.20).ConclusionTumor size, pathologic margin distance and stromal invasion seem to be the most important predictors of local vulvar recurrence. We consider the cut-off of 35 mm of tumor size, 15 mm tumor-free surgical margin and stromal invasion >4 mm, high risk predictors of local recurrence rate.

The Impact of Tumor and Lymph Node Characteristics on Disease Free Survival in Squamous Cell Vulvar Cancer.

“…[7][8][9][10][11][12][13][14][15] The results of this study also verified that LN involvement was clearly confirmed as being the most important prognostic factor for both DFS. In the multivariate analysis, LN involvement was the independent prognostic factor regarding DFS in the current study.…”

“…10 Iacoponi et al reported higher recurrence rate (43.6%) in a study of 87 patients with a median age of 73 years and median tumor size of 35.4 mm. 7 Higher incidence of recurrence might be attributed to the presence of older patients and bigger tumors in that study. On the other hand, Woelber et al reported the recurrence rate as only 13.6% in a study of 109 patients 56% of whom had tumor less ≤ 2 cm in greatest diameter.…”

“…In a recent study, prognostic factors for developing locoregional recurrences were investigated in 78 patients and only receiving adjuvant therapy was found to reduce the perineal and groin recurrence significantly. 7 Although, distinct criteria for indication of adjuvant therapy following primary tumor resection are still under debate, survival advantage of adjuvant RT on patients with two or more metastatic LNs was confirmed in the literature. 18 On the other hand, the status of patients who had one intracapsular LN involvement is controversial.…”

“…Similarly, Iacoponi et al also reported that bilateral LN metastasis was also tend to be associated with higher locoregional recurrences rate compared to unilateral metastasis. 7 Up to date, the number of optimal lymph node number that should be removed is not clarified yet. Few authors investigated the prognostic significance of the number of removed LNs in vulvar cancer and conflicting results were reported.…”

Predictors and Patterns of Local, Regional, and Distant Failure in Squamous Cell Carcinoma of the Vulva

“…[3][4][5] Although several studies aimed to report the safety and long-term oncologic effectiveness or even less demolitive procedures existed, [3][4][5][6] only few investigations investigated possible risk factors for developing failure and often did not subdivide for the occurrence of different patterns of failure (ie, local, regional, and distant). [6][7][8] Hence, in the present study we aimed to report predictors of failure in squamous cell VC. In addition, we sought to describe outcomes of a consecutive series of squamous cell VC, and how the introduction of sentinel node biopsy and less radical vulvar surgery influenced long-term survival outcomes.…”