Prognostic factors in patients with vulvar cancer: the VULCAN study

Abstract

ObjectiveThis study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer.MethodsThis international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed.ResultsAfter excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget’s disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05).ConclusionsAdvanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

Electrochemotherapy in Vulvar Cancer and Cisplatin Combined with Electroporation. Systematic Review and In Vitro Studies

“…Vulvar carcinoma (VC) is a rare disease (5% of all gynecological neoplasms) with the highest incidence in the elderly, although, in recent years, the spread of human papilloma virus (HPV) infection in young women changed this trend [ 1 ]. Squamous cell carcinoma (SCC) is the most frequent histological type (90% of cases), although several rare entities such as melanoma, extra-mammary Paget’s disease, Bartholin’s gland adenocarcinoma, verrucous carcinoma, basal cell carcinoma (BCC), and sarcoma can occur [ 2 , 3 , 4 ]. Surgery is the standard treatment, frequently combined with neoadjuvant chemoradiation; alternatively, the treatment is based on exclusive chemoradiation, based on disease site and patient’s performance status [ 5 ].…”

Surgical Management of Vulvar Melanoma: A Case Series

“…However, the vulvar location is the most frequent site of female genital tract melanoma [ 2 ], representing approximately 1% of melanomas [ 6 ]. VMM has a poor prognosis and is the vulvar cancer type with the worst prognosis [ 3 ], especially in those with regional and distant metastatic disease [ 6 ]. Prognostic factors include disease stage, tumour size, patient age, comorbidities, and insurance status [ 7 ].…”

“…This is attributable to patients delaying consultation [ 8 ]. Thus, late diagnosis considerably reduces the survival [ 3 ].…”

“…Vulvar malignant melanoma (VMM) is the second most common subtype of all vulvar cancers, accounting for 5–10% of all cases [ 2 ], while squamous cell carcinoma represents up to 90% of all vulvar cancers. VMM is the strain of vulvar cancer with the worst prognosis [ 3 ], and it is frequently diagnosed at late stages [ 4 ]. Its surgical treatment has evolved from radical vulvectomy to more conservative surgical procedures, such as wide local excision (WLE) [ 4 , 5 ].…”

The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study

“…A Surveillance, Epidemiology and End Results (SEER) study of 141 patients with FIGO stages I/II disease treated in 1999 reported that 47% of patients were treated with a radical vulvectomy [20]. More recently, a 2020 study, which included a cohort of 1535 patients treated for all stages of squamous vulvar cancer between 2001 and 2005 across 100 European centres reported radical vulvectomy in 76.5% and bilateral groin dissection in 45.2% of patients [21].…”