Prognostic impact of reduced tumor-free margin distance on long-term survival in FIGO stage IB/II vulvar squamous cell carcinoma

Abstract

ObjectiveWe aimed to identify the minimum tumor-free margin distance conferring long-term oncological safety in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB/II vulvar squamous cell carcinoma (VSCC).MethodsThis was a retrospective cohort study in patients with stage IB/II VSCC treated at a single institution in Turin, Italy. The main aim was to identify the minimum tumor-free margin distance that confers oncological safety in early-stage VSCC. Patients were divided in groups according to tumor-free histological margin distance to compare survival outcomes. Overall survival (OS), disease-specific survival (DSS), and recurrence rate (RR) were estimated by the Kaplan-Meier method for the newly proposed and the currently recommended 8 mm margin cut-off. Log-rank test was used to compare survival between groups.ResultsOne hundred and fourteen patients met the study criteria. Median age was 68 years and median follow-up was 80 months. The minimum margin distance that conferred long-term oncological safety was 5 mm. OS, DSS were significantly lower in the <5 mm group when compared with the ≥5 mm group (p=0.002 and p=0.033, respectively) although no difference in RR was observed between groups. Analysis at the 8-mm cut-off indicated there is no difference in OS, DSS, or RR between groups.ConclusionFIGO stage IB/II VSCC patients' prognosis is affected by margin distance. Long-term survival is significantly reduced in patients with tumor-free margins <5 mm, even in the absence of lymph node metastasis. Thus, these patients should be offered further surgical or adjuvant treatment.

Retrospective cohort study of neoadjuvant chemotherapy followed by tailored surgery in locally advanced sphincter-threatening vulval cancer: an alternative to exenteration?

“…The ethos at our centre is to reserve radiotherapy for inoperable recurrence but, moving forward, adjuvant radiation to the vulva will be strongly considered, especially if the margin obtained is <2 mm and/or disease is located at the urethra, in accordance with the risk factors associated with local failure in this study. Recent data indicates that the traditional 8mm clearance may be unnecessary and aiming for 2 mm may be sufficient [29], but this has not yet been proven in more advanced disease.…”

Comparison of two types of the triple incision technique in the treatment of patients with locally advanced vulvar cancer

“…However, a recent multicenter cohort study by the Francogyn Study Group, where 112 vulvar cancer patients who received treatment in four French university hospitals were included, did not find that tumor-free margin distance had survival influence [26]. In Micheletti's study [27] which included 114 patients, the minimum histological margin distance that conferred long-term oncological safety was 5 mm. Of note, this study reviewed data from 1981 to 2014, during which time the management of vulvar cancer has changed considerably.…”

Superficially Invasive Vulvar Squamous Cell Carcinoma: A 37-Year-Long Experience of a Tertiary Referral Center

“…A recent study [38] on 112 VSCCs (including 54 FIGO stage I, of which 7 were IA and 43 were IB) demonstrated a potential benefit in re-intervention if tumor-free margin was <3 mm. Other authors have also shown an increased risk of recurrence, particularly if the tumor-free surgical margin is <5 mm [39,40]; however, the prognostic significance of surgical margins status in SISCCA is still unclear. There is no evidence that a more aggressive surgical approach provides a benefit in disease free-survival (DFS) and overall survival (OS).…”