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Resection margins do not influence survival in vulvar cancer: treatment results in patients with a long-term follow-up
Affiliations- Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Biostatics, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- 2nd Chair and Department Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
open access
Abstract
Introduction. The main purpose of the study was to assess margin resection as a prognostic factor of vulvar cancer in patients with a long term follow-up.
Materials and methods. The study included 84 vulvar cancer patients who underwent radical treatment: surgery (n = 84), radiotherapy (n = 16), chemoradiotherapy (n = 5). Clinicopathological factors regarding survival and recurrence were analyzed. The median follow-up was 74 months.
Results. Resection margins were not related to progression-free survival (PFS) (p = 0.93) and overall survival (OS) (p = 0.84). On the multivariate analysis, a maximum tumor size > 25 mm (p = 0.026) and inguinal lymph node involvement (p = 0.028) were factors increasing the risk of death. The risk of recurrence was related to tumor dimension > 25 mm (p = 0.011), but not to inguinal node metastasis (p = 0.086).
Discussion. Inadequate surgical margin would be salvaged by adjuvant treatment.
Conclusions. A maximum tumor dimension > 25 mm and metastases in the inguinal lymph nodes are independent prognostic factors for the survival of patients with vulvar cancer.
Abstract
Introduction. The main purpose of the study was to assess margin resection as a prognostic factor of vulvar cancer in patients with a long term follow-up.
Materials and methods. The study included 84 vulvar cancer patients who underwent radical treatment: surgery (n = 84), radiotherapy (n = 16), chemoradiotherapy (n = 5). Clinicopathological factors regarding survival and recurrence were analyzed. The median follow-up was 74 months.
Results. Resection margins were not related to progression-free survival (PFS) (p = 0.93) and overall survival (OS) (p = 0.84). On the multivariate analysis, a maximum tumor size > 25 mm (p = 0.026) and inguinal lymph node involvement (p = 0.028) were factors increasing the risk of death. The risk of recurrence was related to tumor dimension > 25 mm (p = 0.011), but not to inguinal node metastasis (p = 0.086).
Discussion. Inadequate surgical margin would be salvaged by adjuvant treatment.
Conclusions. A maximum tumor dimension > 25 mm and metastases in the inguinal lymph nodes are independent prognostic factors for the survival of patients with vulvar cancer.
Keywords
vulva; cancer; prognosis; recurrence
About this articleTitle
Resection margins do not influence survival in vulvar cancer: treatment results in patients with a long-term follow-up
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Research paper (original)
Pages
290-295
Published online
2021-08-20
Page views
6198
Article views/downloads
389
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2021;71(5):290-295.
Keywords
vulva
cancer
prognosis
recurrence
Authors
Szymon Piątek
Wojciech Michalski
Mariusz Bidziński
Anna Dańska-Bidzińska
References (30)- NCCN Clinical Practice Guidelines in Oncology. Vulvar Cancer (Squamous Cell Carcinoma). Version 2.2019. https://www2.tri-kobe.org/nccn/guideline/gynecological/english/vulvar.pdf.
- 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.
- Pijnenborg JMA, Boll D, Hermans RH, et al. Recurrence rate in vulvar carcinoma in relation to pathological margin distance. Int J Gynecol Cancer. 2010; 20(5): 869–873.
- 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.
- Imoto S, Inamine M, Kudaka W, et al. Prognostic factors in patients with vulvar cancer treated with primary surgery: a single-center experience. Springerplus. 2016; 5: 125.
- 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.
- Micheletti L, Preti M, Cintolesi V, et al. Prognostic impact of reduced tumor-free margin distance on long-term survival in FIGO stage IB/II vulvar squamous cell carcinoma. J Gynecol Oncol. 2018; 29(5): e61.
- 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.
- Raimond E, Delorme C, Ouldamer L, et al. Research group FRANCOGYN. Surgical treatment of vulvar cancer: Impact of tumor-free margin distance on recurrence and survival. A multicentre cohort analysis from the francogyn study group. Eur J Surg Oncol. 2019; 45(11): 2109–2114.
- Bedell SM, Hedberg C, Griffin A, et al. Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins. Gynecol Oncol. 2019; 154(2): 276–279.
- Arvas M, Kahramanoglu I, Bese T, et al. The Role of Pathological Margin Distance and Prognostic Factors After Primary Surgery in Squamous Cell Carcinoma of the Vulva. Int J Gynecol Cancer. 2018; 28(3): 623–631.
- 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.
- Schnürch HG, Ackermann S, Alt CD, et al. Diagnosis, Therapy and Follow-up Care of Vulvar Cancer and its Precursors. Guideline of the DGGG and DKG (S2k-Level, AWMF Registry Number 015/059, November 2015. Geburtshilfe Frauenheilkd. 2016; 76(10): 1035–1049.
- 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.
- Te Grootenhuis NC, Pouwer AFW, de Bock GH, et al. Prognostic factors for local recurrence of squamous cell carcinoma of the vulva: A systematic review. Gynecol Oncol. 2018; 148(3): 622–631.
- 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.
- Minar L, Felsinger M, Cihalova M, et al. Vulvar cancer recurrence - an analysis of prognostic factors in tumour-free pathological margins patients group. Ginekol Pol. 2018; 89(8): 424–431.
- Hay CM, Lachance JA, Lucas FL, et al. Biomarkers p16, Human Papillomavirus and p53 Predict Recurrence and Survival in Early Stage Squamous Cell Carcinoma of the Vulva. J Low Genit Tract Dis. 2016; 20(3): 252–256.
- Ferrari F, Forte S, Ardighieri L, et al. Multivariate analysis of prognostic factors in primary squamous cell vulvar cancer: The role of perineural invasion in recurrence and survival. Eur J Surg Oncol. 2019; 45(11): 2115–2119.
- Wu SG, Zhang WW, Sun JY, et al. Prognostic Value of the Number of Removed Lymph Nodes in Vulvar Squamous Cell Carcinoma Patients With Node-Positive Disease: A Population-Based Study. Front Oncol. 2018; 8: 184.
- Mahner S, Jueckstock J, Hilpert F, et al. AGO-CaRE 1 investigators. Adjuvant therapy in lymph node-positive vulvar cancer: the AGO-CaRE-1 study. J Natl Cancer Inst. 2015; 107(3).
- Schwameis R, Postl M, Bekos C, et al. Prognostic value of serum creatine level in patients with vulvar cancer. Sci Rep. 2019; 9(1): 11129.
- Woelber L, Eulenburg C, Kosse J, et al. AGO-CaRE 1 investigators. Predicting the course of disease in recurrent vulvar cancer - A subset analysis of the AGO-CaRE-1 study. Gynecol Oncol. 2019; 154(3): 571–576.
- Blecharz P, Karolewski K, Bieda T, et al. Prognostic factors in patients with carcinoma of the vulva--our own experience and literature review. Eur J Gynaecol Oncol. 2008; 29(3): 260–263.
- Nicoletto MO, Parenti A, Del Bianco P, et al. Vulvar cancer: prognostic factors. Anticancer Res. 2010; 30(6): 2311–2317.
- Polterauer S, Schwameis R, Grimm C, et al. VULCAN Study Collaborative Group. Prognostic value of lymph node ratio and number of positive inguinal nodes in patients with vulvar cancer. Gynecol Oncol. 2017; 147(1): 92–97.
- Sznurkowski JJ, Milczek T, Emerich J. Prognostic factors and a value of 2009 FIGO staging system in vulvar cancer. Arch Gynecol Obstet. 2013; 287(6): 1211–1218.
- 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.
- Zapardiel I, Iacoponi S, Coronado P, et al. Prognostic factors in patients with vulvar cancer: the VULCAN study. Int J Gynecol Cancer. 2020; 30(9): 1285–1291.
- 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.