Prognostic factors for recurrence and survival in uncommon variants of vulvar cancer
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GYNECOLOGIC ONCOLOGY
Prognostic factors for recurrence and survival in uncommon variants of vulvar cancer Ignacio Zapardiel1 · Myriam Gracia1 · Javier Díez2 · Alessandro Buda3 · Maria C. Noya4 · Pierandrea De Iaco5 · Pedro Vieira‑Baptista6 · Sara Iacoponi1 · VULCAN Study collaborative group Received: 14 May 2020 / Accepted: 18 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To analyze the prognostic factors of recurrence and overall survival in rare histotypes of vulvar cancer. Methods An international multicenter retrospective study including patients diagnosed with vulvar cancer was performed. One hundred centers participated in the study and 2453 vulvar cancer cases were enrolled from January 2001 until December 2005. After exclusion of squamous vulvar cancer, Paget´s disease and vulvar melanoma 112 tumors were analyzed for the present study. Results The mean age at diagnosis was 64.9 ± 17.2 years. 99 (88.4%) patients had a single lesion, in 25 (22.3%) cases the vulvar tumor involved the midline, and only 13 (11.5%) patients had clinically positive inguinal lymph nodes. The mean size of the lesion was 33.8 ± 33.9 mm. Regarding the surgical treatment, 2 (1.8%) patients underwent skinning vulvectomy, 63 (56.3%) local excision, 41 (36.6%) vulvectomy, 3 (2.7%) exenteration and 3 (2.7%) did not receive any surgical treatment. The mean free surgical margin was 8.2 ± 9 mm and 7 (6.2%) patients presented positive inguinal nodes. Radiotherapy was administered in 22 (19.6%) patients and it was performed postoperatively in all cases; 14 (12.5%) patients received adjuvant chemotherapy. The mean overall follow-up time was 44.1 ± 35.7 months. The risk factors associated with overall survival were chemotherapy and radiotherapy, tumor size and stromal invasion (p 1
64.8 ± 17.2 19 (17.2%) 93 (82.8%) 30 (26.7%) 82 (73.3%) 36 (32.4%) 76 (67.6%) 94 (83.9%) 18 (16.1%) 29 (26.1%) 9 (8%) 70 (62.5%) 4 (3.4%) 99 (88.4%) 13 (11.6%)
SD standard deviation
13
Archives of Gynecology and Obstetrics
Table 3 Pathologic and surgical characteristics of patients with uncommon vulvar cancer (n = 112) Characteristics
Number of cases
Age, years (mean ± SD) Midline affectation Stromal invasion, mm (mean ± SD) FIGO stage I II III IV Free margin, mm (mean ± SD) Surgical procedure Skinning vulvectomy Local wide excision Radical and simple vulvectomy Exenteration None Unilateral lymphadenectomy Yes No Bilateral lymphadenectomy Yes No Sentinel node biopsy Surgical reconstruction Radiotherapy Yes No Chemotherapy Yes No
33.8 ± 33.9 25 (22.3%) 6.1 ± 20.6 84 (75%) 13 (11.6%) 10 (8.9%) 5 (4.5%) 8.9 ± 9.09 2 (1.8%) 63 (56.3%) 41 (36.6%) 3 (2.7%) 3 (2.7%) 28 (25%) 84 (75%) 66 (59%) 46 (41%) 9 (8%) 16 (14.3%) 22 (19.6%) 90 (80.4%) 14 (12.5%) 98 (87.5%)
Mm milimeters, FIGO International Federation of Gynecology and Obstetrics, SD standard deviation
factor which decreased the recurrence rate was radiotherapy (p = 0.02). The lack of radiation therapy treatment was associated with the development of me
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