Role of pelvic lymph node resection in vulvar cancer – a subset analysis of the AGO-CaRE-1 study

Woelber, Linn; Bommert, Mareike; Harter, Philipp; Eulenburg, Christine zu; Jueckstock, J; Hilpert, Felix; Gregorio, Nikolaus de; Iborra, Séverine; Sehouli, Jalid; Ignatov, Atanas; Hillemanns, Peter; Fuerst, Sophie; Strauss, H. G.; Baumann, Klaus; Thiel, Falk; Mustea, A.; Meier, W.; Wimberger, Pauline; Hanker, Lars; Schmalfeldt, Barbara; Canzler, Ulrich; Fehm, Tanja; Luyten, Alexander; Hellriegel, Martin; Kosse, Jens; Heiss, C.; Hantschmann, Peer; Mallmann, Peter; Berno, Tamara; Pfisterer, Jacobus; Mahner, Sven; Jaeger, Anna

doi:10.1055/s-0040-1717203

Cited by 2 publications

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“…8/70 patients (11.4%) died before recurrence occurred (median follow-up: 21.13 months). As expected, the risk of recurrence in patients with pelvic lymph node involvement was higher compared to patients without pelvic lymph node involvement (8/14 patients, 57.1% vs. 17/43 patients, 39.5%) 15 . The single-center evaluation at the UKE found that 23.8% of patients (5/21) developed recurrence: 3/6 of pelvic node-positive patients (50%) and 2/15 of pelvic node-negative patients (13.3%) developed recurrence.…”

Section: Reviewsupporting

confidence: 78%

“…In their study, neither initial pelvic involvement nor the development of pelvic recurrence was observed in patients with ≤ 2 positive inguinal lymph nodes, whereas pelvic metastasis was detected in 2/3 patients (66.6%) with 3 positive inguinal lymph nodes and in 5/6 patients (83.3%) with ≥ 4 positive inguinal lymph nodes. Although there are reports that in some patient populations the risk of pelvic involvement already begins to increase when patients have ≥ 3 positive inguinal LNs 12 , 24 , the CaRE-1 subgroup analysis was only able to make a valid prognosis about pelvic involvement for patients with ≥ 6 positive inguinal LNs 15 . In the UKE cohort, the positive predictive value for pelvic involvement in patients with ≥ 3 ipsilateral inguinal lymph nodes was 62.5% and the negative predictive value was 88.5%.…”

Section: Reviewmentioning

confidence: 94%

“…Unfortunately, the diameter of the inguinal lymph node metastasis was not documented for this specific patient. ROC analysis showed an AUC of 0.85 with a sensitivity of 83.3% and a specificity of 92.6% for the prediction of pelvic lymph node involvement in case of ≥ 6 positive inguinal lymph nodes 15 .…”

Section: Reviewmentioning

confidence: 98%

“…Because of the respective survey periods, tumor staging in both cohorts was done using the TNM classification of the Union internationale contre le cancer (UICC), version 6 14 . During the subgroup analysis of the CaRE-1 study 5 , 15 , 70 patients with known inguinal lymph node status who underwent surgical pelvic staging (pelvic LAE) were identified 15 . The median patient age was 63 years (range: 20 – 85 years) and the median follow-up (FU) was 31 months.…”

Section: Reviewmentioning

confidence: 99%

“…Aufgrund der Erhebungszeiträume erfolgte die Einteilung der Tumorstadien in beiden Kollektiven anhand der Union internationale contre le cancer-(UICC-)TNM-Klassifikation Version 6 14 . Im Rahmen der Subgruppenanalyse der CaRE-1-Studie 5 , 15 wurden n = 70 Patientinnen mit chirurgischem Staging des Beckens (pelvine LNE) und bekanntem Lymphknotenstatus der Leiste identifiziert 15 . Das mediane Alter betrug 63 Jahre (Range: 20 – 85 Jahre) und das mediane Follow-up (FU) 31 Monate.…”

Section: üBersicht/reviewunclassified

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Pelvic Lymphadenectomy in Vulvar Cancer – Does it make sense?

Woelber

Bommert

Fischer

et al. 2020

Geburtshilfe Frauenheilkd

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Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient populations who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multicenter AGO CaRE-1 study (1998 – 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with primary VSCC treated between 1996 – 2018 were evaluated, 21 of whom underwent pelvic LAE. In both cohorts, around 80% of the patients who underwent pelvic LAE were inguinally node-positive, with a median number of three affected groin lymph nodes. There were no cases of pelvic lymph node metastasis without inguinal lymph node metastasis in either of the two cohorts. Between 33 – 35% of the inguinal node-positive patients also had pelvic lymph node metastasis; the median number of affected groin lymph nodes in these patients was high (> 4), and the maximum median diameter of the largest inguinal metastasis was > 40 mm in both cohorts. Pelvic lymph node staging and pelvic radiotherapy is therefore probably not necessary for the majority of node-positive patients with VSCC, as the relevant risk of pelvic lymph node involvement was primarily found in node-positive patients with high-grade disease. More, ideally prospective data collections are necessary to validate the relation between inguinal and pelvic lymph node involvement.

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Section: Reviewsupporting

confidence: 78%

Section: Reviewmentioning

confidence: 94%

Section: Reviewmentioning

confidence: 98%

Section: Reviewmentioning

confidence: 99%

Section: üBersicht/reviewunclassified

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Pelvic Lymphadenectomy in Vulvar Cancer – Does it make sense?

Woelber

Bommert

Fischer

et al. 2020

Geburtshilfe Frauenheilkd

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Pelvic lymphadenectomy in vulvar cancer and its impact on prognosis and outcome

Jaeger

Mathey

Fischer

et al. 2021

Arch Gynecol Obstet

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Background The value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general. Patients and Methods N = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018. In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement. Results The majority had T1b/T2 tumors (n = 15, 78.9%) with a median diameter of 40 mm (11–110 mm). 17/21 patients showed positive inguinal nodes. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients with positive groin nodes also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1–8)). These 6 patients were highly node positive with median 4.5 (2–9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed. Five recurrences were observed after a median follow-up of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group. Patients with pelvic metastasis at first diagnosis had a median progression-free survival of only 9.9 months and overall-survival of 31.1 months. Conclusion A relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.

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Role of pelvic lymph node resection in vulvar cancer – a subset analysis of the AGO-CaRE-1 study

Cited by 2 publications

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Pelvic Lymphadenectomy in Vulvar Cancer – Does it make sense?

Pelvic Lymphadenectomy in Vulvar Cancer – Does it make sense?

Pelvic lymphadenectomy in vulvar cancer and its impact on prognosis and outcome

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