open access

Vol 89, No 8 (2018)
Research paper
Published online: 2018-08-31
Get Citation

Vulvar cancer recurrence — an analysis of prognostic factors in tumour-free pathological margins patients group

Lubos Minar12, Michal Felsinger12, Marta Cihalova1, Filip Zlamal2, Julie Bienertova-Vasku2
DOI: 10.5603/GP.a2018.0073
·
Pubmed: 30215461
·
Ginekol Pol 2018;89(8):425-432.
Affiliations
  1. University Hospital Brno, Brno, Czech Republic
  2. Masaryk University, Brno, Czech Republic

open access

Vol 89, No 8 (2018)
ORIGINAL PAPERS Gynecology
Published online: 2018-08-31

Abstract

Objectives: To evaluate risk factors associated with the local recurrence of invasive squamous cell vulvar cancer in patient group with tumor-free pathological margins.

Material and methods: This is a retrospective analysis of 47 patients who underwent surgical treatment at University Hospital Brno, the Czech Republic between 2007 and 2014. 24 patients were classified as IB stage and three as II stage. A further 20 patients representing stage III showed the metastatic involvement of regional lymph nodes. Seven prognostic factors were analyzed in relation to local tumour recurrence: tumour size, margin distance, depth of invasion, lymphovascular space involvement (LVSI), midline involvement, metastatic lymph nodes and FIGO stage.

Results: All prognostic factors were found to be statistically significant with respect to the risk of local recurrence. The highest risk of local recurrence was observed for the depth of invasion > 5 mm (HR, 12.42 [95% CI; 3.44–44.84]) and for the presence of LVSI (HR, 10.83 [95% CI; 3.87–30.28]). The study also established a clear difference in the risk of local recurrence between patient groups with resection margin < 8 vs. ≥ 8 mm (HR, 4.91 [95% CI; 1.73–13.93; p = 0.003].

Conclusions: Tumour-free pathological margin of ≥ 8 mm is a major prognostic factor of local recurrence which can be influenced by the surgeon. A perfect knowledge of the extent of the disease prior to surgery supports adequately radical surgical trends. The emphasis is given on adequate radicality as well as on the reduction of overtreatment without worse­ning prognosis by simultaneously preserving the quality of life.

Abstract

Objectives: To evaluate risk factors associated with the local recurrence of invasive squamous cell vulvar cancer in patient group with tumor-free pathological margins.

Material and methods: This is a retrospective analysis of 47 patients who underwent surgical treatment at University Hospital Brno, the Czech Republic between 2007 and 2014. 24 patients were classified as IB stage and three as II stage. A further 20 patients representing stage III showed the metastatic involvement of regional lymph nodes. Seven prognostic factors were analyzed in relation to local tumour recurrence: tumour size, margin distance, depth of invasion, lymphovascular space involvement (LVSI), midline involvement, metastatic lymph nodes and FIGO stage.

Results: All prognostic factors were found to be statistically significant with respect to the risk of local recurrence. The highest risk of local recurrence was observed for the depth of invasion > 5 mm (HR, 12.42 [95% CI; 3.44–44.84]) and for the presence of LVSI (HR, 10.83 [95% CI; 3.87–30.28]). The study also established a clear difference in the risk of local recurrence between patient groups with resection margin < 8 vs. ≥ 8 mm (HR, 4.91 [95% CI; 1.73–13.93; p = 0.003].

Conclusions: Tumour-free pathological margin of ≥ 8 mm is a major prognostic factor of local recurrence which can be influenced by the surgeon. A perfect knowledge of the extent of the disease prior to surgery supports adequately radical surgical trends. The emphasis is given on adequate radicality as well as on the reduction of overtreatment without worse­ning prognosis by simultaneously preserving the quality of life.

Get Citation

Keywords

squamous cell vulvar cancer, surgical treatment, tumour-free pathological margins, local recurrence

Supp./Additional Files (1)
Ethics Committee Approval
Download
246KB
About this article
Title

Vulvar cancer recurrence — an analysis of prognostic factors in tumour-free pathological margins patients group

Journal

Ginekologia Polska

Issue

Vol 89, No 8 (2018)

Article type

Research paper

Pages

425-432

Published online

2018-08-31

DOI

10.5603/GP.a2018.0073

Pubmed

30215461

Bibliographic record

Ginekol Pol 2018;89(8):425-432.

Keywords

squamous cell vulvar cancer
surgical treatment
tumour-free pathological margins
local recurrence

Authors

Lubos Minar
Michal Felsinger
Marta Cihalova
Filip Zlamal
Julie Bienertova-Vasku

References (34)
  1. Howlader N, Noone AM, Krapcho M, et al. (eds) (2015) SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, based on November 2014 SEER data submission, posted to the SEER web site, April 2015. http://seer.cancer.gov/csr/1975_2012/ (30.12.2016).
  2. Woelber L, Kock L, Gieseking F, et al. Clinical management of primary vulvar cancer. Eur J Cancer. 2011; 47(15): 2315–2321.
  3. Oonk MHM, Planchamp F, Baldwin P, et al. European Society of Gynaecological Oncology Guidelines for the Management of Patients With Vulvar Cancer. Int J Gynecol Cancer. 2017; 27(4): 832–837.
  4. Sznurkowski JJ. Vulvar cancer: initial management and systematic review of literature on currently applied treatment approaches. Eur J Cancer Care (Engl). 2016; 25(4): 638–646.
  5. Aviki EM, Esselen KM, Barcia SM, et al. Does plastic surgical consultation improve the outcome of patients undergoing radical vulvectomy for squamous cell carcinoma of the vulva? Gynecol Oncol. 2015; 137(1): 60–65.
  6. Gentileschi S, Servillo M, Garganese G, et al. Surgical therapy of vulvar cancer: how to choose the correct reconstruction? J Gynecol Oncol. 2016; 27(6): e60.
  7. Reade CJ, Eiriksson LR, Mackay H. Systemic therapy in squamous cell carcinoma of the vulva: current status and future directions. Gynecol Oncol. 2014; 132(3): 780–789.
  8. Graham K, Burton K. "Unresectable" vulval cancers: is neoadjuvant chemotherapy the way forward? Curr Oncol Rep. 2013; 15(6): 573–580.
  9. Ramanah R, Lesieur B, Ballester M, et al. Trends in of late-stage squamous cell vulvar carcinomas: analysis of the surveillance, epidemiology, and end results (SEER) database. Int J Gynecol Cancer. 2012; 22(5): 854–859.
  10. Gadducci A, Ferrero A, Tana R, et al. Clinico-pathological and biological prognostic variables in squamous cell carcinoma of the vulva. Crit Rev Oncol Hematol. 2012; 83(1): 71–83.
  11. Iacoponi S, Zapardiel I, Diestro MD, et al. Prognostic factors associated with local recurrence in squamous cell carcinoma of the vulva. J Gynecol Oncol. 2013; 24(3): 242–248.
  12. Yap J, O'Neill D, Nagenthiran S, et al. Current insights into the aetiology, pathobiology, and management of local disease recurrence in squamous cell carcinoma of the vulva. BJOG. 2017; 124(6): 946–954.
  13. Cormio G, Loizzi V, Carriero C, et al. Groin recurrence in carcinoma of the vulva: management and outcome. Eur J Cancer Care (Engl). 2010; 19(3): 302–307.
  14. Klapdor R, Hertel H, Soergel P, et al. Groin Recurrences in Node Negative Vulvar Cancer Patients After Sole Sentinel Lymph Node Dissection. Int J Gynecol Cancer. 2017; 27(1): 166–170.
  15. Mahner S, Prieske K, Grimm D, et al. Systemic treatment of vulvar cancer. Expert Rev Anticancer Ther. 2015; 15(6): 629–637.
  16. Woelber L, Mahner S, Voelker K, et al. Clinicopathological prognostic factors and patterns of recurrence in vulvar cancer. Anticancer Res. 2009; 29(2): 545–552.
  17. Deka P, Barmon D, Shribastava S, et al. Prognosis of vulval cancer with lymph node status and size of primary lesion: A survival study. J Midlife Health. 2014; 5(1): 10–13.
  18. Bogani G, Cromi A, Serati M, et al. Predictors and Patterns of Local, Regional, and Distant Failure in Squamous Cell Carcinoma of the Vulva. Am J Clin Oncol. 2017; 40(3): 235–240.
  19. Nooij LS, Ongkiehong PJ, van Zwet EW, et al. Groin surgery and risk of recurrence in lymph node positive patients with vulvar squamous cell carcinoma. Gynecol Oncol. 2015; 139(3): 458–464.
  20. Robertson NL, Hricak H, Sonoda Y, et al. The impact of FDG-PET/CT in the management of patients with vulvar and vaginal cancer. Gynecol Oncol. 2016; 140(3): 420–424.
  21. Lin G, Chen CY, Liu FY, et al. Computed tomography, magnetic resonance imaging and FDG positron emission tomography in the management of vulvar malignancies. Eur Radiol. 2015; 25(5): 1267–1278.
  22. Nooij LS, Brand FAM, Gaarenstroom KN, et al. Risk factors and treatment for recurrent vulvar squamous cell carcinoma. Crit Rev Oncol Hematol. 2016; 106: 1–13.
  23. Coulter J, Gleeson N. Local and regional recurrence of vulval cancer: management dilemmas. Best Pract Res Clin Obstet Gynaecol. 2003; 17(4): 663–681.
  24. Rouzier R, Haddad B, Plantier F, et al. Local relapse in patients treated for squamous cell vulvar carcinoma: incidence and prognostic value. Obstet Gynecol. 2002; 100(6): 1159–1167.
  25. Dusek L Muzik J, Kubasek M, et al. (eds) (2005) Epidemiology of malignant tumors in the Czech Republic, 1977-2015, Masaryk University, Brno. http://www.svod.cz/report.php/ (20.06.2018).
  26. Woelber L, Griebel LF, Eulenburg C, et al. Role of tumour-free margin distance for loco-regional control in vulvar cancer-a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study. Eur J Cancer. 2016; 69: 180–188.
  27. Nooij LS, van der Slot MA, Dekkers OM, et al. Tumour-free margins in vulvar squamous cell carcinoma: Does distance really matter? Eur J Cancer. 2016; 65: 139–149.
  28. Woelber L, Choschzick M, Eulenburg C, et al. Prognostic value of pathological resection margin distance in squamous cell cancer of the vulva. Ann Surg Oncol. 2011; 18(13): 3811–3818.
  29. Viswanathan AN, Pinto AP, Schultz D, et al. Relationship of margin status and radiation dose to recurrence in post-operative vulvar carcinoma. Gynecol Oncol. 2013; 130(3): 545–549.
  30. Baiocchi G, Mantoan H, de Brot L, et al. How important is the pathological margin distance in vulvar cancer? Eur J Surg Oncol. 2015; 41(12): 1653–1658.
  31. Holthoff ER, Jeffus SK, Gehlot A, et al. Perineural Invasion Is an Independent Pathologic Indicator of Recurrence in Vulvar Squamous Cell Carcinoma. Am J Surg Pathol. 2015; 39(8): 1070–1074.
  32. Holthoff ER, Spencer H, Kelly T, et al. Pathologic features of aggressive vulvar carcinoma are associated with epithelial-mesenchymal transition. Hum Pathol. 2016; 56: 22–30.
  33. Nooij LS, Ter Haar NT, Ruano D, et al. Genomic Characterization of Vulvar (Pre)cancers Identifies Distinct Molecular Subtypes with Prognostic Significance. Clin Cancer Res. 2017; 23(22): 6781–6789.
  34. Trietsch MD, Nooij LS, Gaarenstroom KN, et al. Genetic and epigenetic changes in vulvar squamous cell carcinoma and its precursor lesions: a review of the current literature. Gynecol Oncol. 2015; 136(1): 143–157.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl