Safety and Benefit Of Sentinel Lymph Nodes Biopsy Compared to Regional Lymph Node Dissection in Primary Vulvar Cancer Patients Without Distant Metastasis and Adjacent Organ Invasion: A Retrospective Population Study

Abstract

BackgroundThe safety and benefit of sentinel lymph node biopsy (SLNB) compared with regional lymph node dissection (RLND) and no lymph nodes removed (NA) in patients with vulvar squamous cell cancer (VSCC) was not well studied.MethodsA retrospective analysis on VSCC patients without distant metastasis and adjacent organ invasion from the Surveillance, Epidemiology, and End Results Program database between 2004 and 2016 was carried out. Within subgroups stratified by negative (LN−) or positive (LN+) regional lymph node findings, inverse probability weighting (IPW) adjusted multivariate Fine-Gray compete risk (CR) model and accelerated failure time (AFT) model was used to investigate the factors associated with and cancer-specific survival (CSS) and overall survival (OS).ResultsOf the 3,161 VSCC patients treated with surgery, 287 (9.1%) underwent SLNB, 1,716 (54.3%) underwent RLND, and 1,158 (36.6%) had no regional lymph nodes removed. As illustrated by IPW adjusted multivariate regressions, SLNB was significantly associated with prolonged CSS (LN−, adjusted sub-proportional hazard ratio [sHR] = 0.42; 95% confidence interval [CI], 0.19–0.93; P=0.032; LN+, adjusted sHR = 0.29; 95% CI, 0.16–0.54, P<0.001) and OS (LN−, adjusted time ratio [TR] = 1.38; 95% CI, 0.82–2.32; P=0.226; LN+, adjusted TR = 2.68; 95% CI, 1.73–4.14; P<0.001), although the effect of SLNB on OS was not significant within the LN− cohort. Moreover, SLNB led to improved CSS (adjusted sHR = 0.40; 95% CI, 0.23–0.70; P = 0.001) and OS (adjusted TR=1.15, 95% CI 0.76-1.73, P=0.279) compared with NA. Age was a significant prognostic factor of CSS and OS, whereas tumor size, surgery type, and invasion depth were not.ConclusionsSLNB leads to significantly prolonged CSS and OS in VSCC surgery patients without distant metastasis and adjacent organ invasion than RLND, except for the similar OS in the LN− cohort. SLNB could be carried out preferentially for VSCC surgery patients without distant metastasis and adjacent organ invasion, irrespective of tumor size, surgery type, invasion depth, and regional lymph nodes metastasis. Further prospective clinical trials are warranted to confirm the findings of this study.

Developing and Validating Novel Nomograms for Predicting the Overall Survival and Cancer-Specific Survival of Patients With Primary Vulvar Squamous Cell Cancer

“…SLNB and lymphadenectomy have never been integrated as a predictor in nomograms for predicting the survival of patients with VSCC. However, the beneficial role of SLNB in improving survival has been proved in previous studies ( 17 – 19 ). The inclusion of SLNB in the model has improved the prediction accuracy considerably.…”

The Premetastatic Lymph Node Niche in Gynecologic Cancer

“…This could explain the low percentage of lymph-node metastasis in endometrial cancer: 10% for all-grade included endometrial carcinomas [ 11 ], 14% for the sentinel lymph node [ 12 ] or lymphadenectomy approaches [ 13 ], reaching almost 20% (most often micrometastases) even when introducing molecular techniques in the early-stage disease [ 14 ] and raising to 26% for high-grade cancers [ 15 ]. For vulvar cancer-draining lymph nodes, the metastatic ratio is slightly higher, 21–28% [ 16 ]. This could be in-line with the significantly higher PD-L1-positive cells in otherwise healthy vulvar cancer-draining LNs, compared to the endometrial cancer-draining LNs found here.…”

The Role of Ultrasound in the Evaluation of Inguinal Lymph Nodes in Patients with Vulvar Cancer: A Systematic Review and Meta-Analysis

“…The use of this technique has resulted in decreased postoperative morbidity without compromising detection of LN metastases [14][15][16]. Some studies were conducted with the aim of extending the indications for the sentinel lymph node biopsy, which could be reached more easily having in hand an adequate screening tool in the preoperative phase [17][18][19].…”