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Zhao Z, Zhen S, Liu N, Ding D, Zhang D, Kong J. Survival nomograms for vulvar squamous cell carcinoma based on the SEER database and a Chinese external validation cohort. Int J Gynaecol Obstet 2024; 165:1130-1143. [PMID: 38240461 DOI: 10.1002/ijgo.15313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 05/13/2024]
Abstract
OBJECTIVE The aim of study was to construct a nomogram to effectively predict the overall survival (OS) and cancer-specific survival (CSS) for patients with vulvar squamous cell carcinoma (VSCC). METHODS The training cohort consisted of 5405 patients with VSCC, extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Eighty-four patients with VSCC were selected from the disease database of the Shengjing Hospital of China Medical University from 2014 to 2020, and enrolled as the external validation cohort. Significant independent prognostic factors were identified using Cox regression analysis and used to develop nomograms to predict 1-, 3-, and 5-year OS and CSS in patients with VSCC. RESULTS The nomogram predicting OS was developed based on tumor size, histological grade, International Federation of Gynecology and Obstetrics (FIGO) stage, regional lymph node involvement, distant metastases, surgery, chemotherapy, age, and race. The nomogram for CSS was constructed using the similar factors, excluding race but including marital status. The nomogram for 1-, 3-, and 5-year OS demonstrated robust performance with receiver operating characteristic curves (AUCs) exceeding 80% (0.86, 0.84, and 0.82), outperforming the FIGO staging alone (0.77, 0.75, and 0.72). Similarly, for CSS, our nomograms achieved larger AUCs of 0.89, 0.88, and 0.86 compared with FIGO staging alone (0.81, 0.79, and 0.78). CONCLUSION The nomograms more accurately predict prognosis than simple FIGO staging. Moreover, the nomograms developed in this study provide a convenient, operable, and reliable tool for individual assessment and clinical decision-making for patients with VSCC.
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Affiliation(s)
- Zhongyi Zhao
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shihan Zhen
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Ning Liu
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ding Ding
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dandan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Juan Kong
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang, China
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2
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Classen-von Spee S, Baransi S, Fix N, Rawert F, Luengas-Würzinger V, Lippert R, Bonin-Hennig M, Mallmann P, Lampe B. Pelvic Exenteration for Recurrent Vulvar Cancer: A Retrospective Study. Cancers (Basel) 2024; 16:276. [PMID: 38254766 PMCID: PMC10813412 DOI: 10.3390/cancers16020276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Pelvic exenteration (PE) is one of the most radical surgical approaches. In earlier times, PE was associated with high morbidity and mortality. Nowadays, due to improved selection of suitable patients, perioperative settings, and postoperative care, patients' outcomes have been optimized. To investigate patients' outcomes and identify possible influencing clinical and histopathological factors, we analysed 17 patients with recurrent vulvar cancer who underwent PE in our department between 2007 and 2022. The median age was 64.9 years, with a difference of 40 years between the youngest and the oldest patient (41 vs. 81 years). The mean overall survival time was 55.7 months; the longest survival time reached up to 164 months. The achievement of complete cytoreduction (p = 0.02), the indication for surgery (curative vs. palliative), and the presence of distant metastases (both p = 0.01) showed a significant impact on overall survival. The presence of lymphatic metastases (p = 0.11) seems to have an influence on overall survival (OS) time. Major complications appeared in 35% of the patients. Our results support the existing data for PE in cases of recurrent vulvar cancer; for a group of selected patients, PE is a treatment option with good overall survival times and acceptable morbidity.
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Affiliation(s)
- Sabrina Classen-von Spee
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Saher Baransi
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Nando Fix
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Friederike Rawert
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Verónica Luengas-Würzinger
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Ruth Lippert
- Department of Pathology, Evangelisches Krankenhaus Oberhausen, Virchowstraße 20, 46047 Oberhausen, Germany
| | - Michelle Bonin-Hennig
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Björn Lampe
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
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3
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Li M, Li J, Wang Z. Prognostic value of postoperative radiotherapy in patients with vulvar squamous carcinoma: findings based on the SEER database. BMC Womens Health 2023; 23:361. [PMID: 37420200 PMCID: PMC10329365 DOI: 10.1186/s12905-023-02522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 06/30/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION The role of postoperative radiotherapy in treating squamous cell carcinoma of the vulva remains controversial. This study evaluated the effect of radiotherapy on the survival of patients with postoperative squamous cell carcinoma of the vulva. METHODS Clinical and prognostic information on patients diagnosed with vulvar squamous cell carcinoma from 2010 to 2015 was collected from the Surveillance, Epidemiology, and Prognosis (SEER) database. A propensity score matching (PSM) approach was used to balance the differences in clinicopathological characteristics between groups. The impact of postoperative radiotherapy on overall survival (OS) and disease-specific survival (DSS) was assessed. RESULTS The study included 3571 patients with squamous cell carcinoma of the vulva, of whom 732 (21.1%) received postoperative radiotherapy. After propensity score matching, multivariate analysis showed that age, race, N stage, and tumor size were independent influences on overall survival and disease-specific survival of patients. Postoperative radiotherapy did not improve patients' overall survival or disease-specific survival. Further subgroup survival analysis showed that in patients with AJCC stage III, N1 stage, lymph node metastasis, and large tumor diameter (> 3.5 cm), postoperative radiotherapy resulted in a significant improvement in overall patient survival. CONCLUSION Postoperative radiotherapy is not indicated for all patients with postoperative vulvar cancer and has improved survival outcomes only for patients with AJCC stage III, N1, lymph node metastases and large tumor diameter (> 3.5 cm).
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Affiliation(s)
- Miaomiao Li
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No.99, Longcheng Street, Taiyuan, 030032, Shanxi, China
| | - Jing Li
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No.99, Longcheng Street, Taiyuan, 030032, Shanxi, China
| | - Zanhong Wang
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No.99, Longcheng Street, Taiyuan, 030032, Shanxi, China.
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Röhrmoser K, Ignatov A, Gerken M, Ortmann O, Klinkhammer-Schalke M, Papathemelis T. Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration. J Cancer Res Clin Oncol 2023; 149:803-810. [PMID: 35179644 DOI: 10.1007/s00432-022-03954-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND To date, information on risk factors and temporal patterns of recurrences in patients with vulvar cancer is sparse. Conclusive data for an optimal surveillance strategy are lacking. METHODS This multicenter, retrospective population-based register study included 1412 patients who have been treated from 2000 to 2017 for vulvar cancer in the German districts of Upper Palatinate, Lower Bavaria, and Saxony-Anhalt. Kaplan-Meier method, and univariate and multivariate Cox regression were employed to evaluate prognostic factors and temporal course of overall survival, cumulative recurrence, and recurrence-free survival rates. RESULTS After exclusion, the final study cohort comprised 829 patients. Most recurrences occurred within the first 3 years after diagnosis. Notably, a significant subset of patients were recurrent even after 5 years. The cumulative recurrence rate from all relapses was 18.6% 1 year after primary diagnosis. The recurrence rate increased to 34.7% after 3, to 41.8% after 5, and to 56.6% after 10 years post-diagnosis. The risk of relapse was significantly increased in patients over 70 years of age (hazard ratio (HR) = 2.7; p < 0.001; 95% CI 1.6-4.4), and in patients with positive nodal status N1 (HR = 2.0; p = 0.019; 95% CI 1.1-3.5) and N2/3 (HR = 2.2; p = 0.033; 95% CI 1.1-4.4). CONCLUSION Our study provides compelling evidence that follow-up care should be carried out for longer than 5 years, especially for high-risk patients.
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Affiliation(s)
- Katharina Röhrmoser
- Tumor Center, Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Atanas Ignatov
- Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany
| | - Michael Gerken
- Tumor Center, Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany.,Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany.,Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Thomas Papathemelis
- Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany.
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Hoang L, Webster F, Bosse T, Focchi G, Gilks CB, Howitt BE, McAlpine JN, Ordi J, Singh N, Wong RWC, Lax SF, McCluggage WG. Data Set for the Reporting of Carcinomas of the Vulva: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S8-S22. [PMID: 36305532 DOI: 10.1097/pgp.0000000000000900] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A cogent and comprehensive pathologic report is essential for optimal patient management, cancer staging, and prognostication. This article details the International Collaboration on Cancer Reporting (ICCR) process and the development of the vulval carcinoma reporting data set. It describes the "core" and "noncore" elements to be included in pathology reports for vulval carcinoma, inclusive of clinical, macroscopic, microscopic, and ancillary testing considerations. It provides definitions and commentary for the evidence and/or consensus-based deliberations for each element included in the data set. The commentary also discusses controversial issues, such as p16/human papillomavirus testing, tumor grading and measurements, as well as elements that show promise and warrant further evidence-based study. A summary and discussion of the updated vulval cancer staging system by the International Federation of Obstetricians and Gynaecologists (FIGO) in 2021 is also provided. We hope the widespread implementation of this data set will facilitate consistent and accurate reporting, data collection, comparison of epidemiological and pathologic parameters between different populations, facilitate research, and serve as a platform to improve patient outcomes.
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Macchia G, Casà C, Ferioli M, Lancellotta V, Pezzulla D, Pappalardi B, Laliscia C, Ippolito E, Di Muzio J, Huscher A, Tortoreto F, Boccardi M, Lazzari R, De Iaco P, Raspagliesi F, Gadducci A, Garganese G, Ferrandina G, Morganti AG, Tagliaferri L. Observational multicenter Italian study on vulvar cancer adjuvant radiotherapy (OLDLADY 1.2): a cooperation among AIRO Gyn, MITO and MaNGO groups. Radiol Med 2022; 127:1292-1302. [DOI: 10.1007/s11547-022-01538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/28/2022] [Indexed: 12/01/2022]
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7
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Ravaggi A, Gambino A, Ferrari F, Olivari A, Zanotti L, Romani C, Ardighieri L, Antonelli P, Garganese G, Gallo D, Scambia G, Bignotti E, Sartori E, Calza S, Odicino F. VEGF-D Serum Level as a Potential Predictor of Lymph Node Metastasis and Prognosis in Vulvar Squamous Cell Carcinoma Patients. Front Oncol 2022; 12:818613. [PMID: 35463308 PMCID: PMC9026339 DOI: 10.3389/fonc.2022.818613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Radical surgical resection of the primary tumor with mono/bilateral inguinofemoral lymph node dissection is the standard treatment for invasive vulvar squamous cell carcinoma (VSCC) and is frequently related to severe morbidity. Tailoring surgical treatment is of paramount importance, and a comprehensive preoperative evaluation is mandatory. Vascular endothelial growth factor D (VEGF-D) is considered a regulator of lymphangiogenesis involved in tumor spread via lymphatic vessels. The aim of this study was to evaluate the potential of VEGF-D in the prediction of inguinofemoral lymph node metastasis. Methods We analyzed the preoperative levels of serum VEGF-D (sVEGF-D) from two independent cohorts of patients with VSCC by enzyme-linked immunosorbent assay and its protein expression on tumor tissue by immunohistochemistry. Logistic regression was performed to identify the independent risk factors for lymph node metastasis, and Cox proportional hazard model was used for survival analysis. Results High levels of sVEGF-D, but not tissue VEGF-D, significantly correlated with positive groin nodes and a more advanced International Federation of Gynecologists and Obstetricians (FIGO) stage. In multivariable analysis, a high sVEGF-D level was an independent predictor of lymph node metastasis and worse prognosis. A prediction model based on sVEGF-D, tumor grade assessed on biopsy, tumor diameter, and lymph node clinical evaluation was able to predict lymph node metastasis, reaching C-index values of 0.79 and 0.73 in the training and validation cohorts, respectively. Conclusions The preoperative sVEGF-D level might be a reliable biomarker for the prediction of lymph node metastasis and prognosis in patients with VSCC, supporting better clinical/surgical decision. Multicenter prospective studies are required to confirm our findings.
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Affiliation(s)
- Antonella Ravaggi
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.,Division of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy.,'Angelo Nocivelli' Institute of Molecular Medicine, University of Brescia-Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Angela Gambino
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.,Division of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Federico Ferrari
- Division of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Alessandro Olivari
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Laura Zanotti
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.,'Angelo Nocivelli' Institute of Molecular Medicine, University of Brescia-Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Chiara Romani
- 'Angelo Nocivelli' Institute of Molecular Medicine, University of Brescia-Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Laura Ardighieri
- Department of Pathology, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Antonelli
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.,Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Gallo
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Eliana Bignotti
- Division of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy.,'Angelo Nocivelli' Institute of Molecular Medicine, University of Brescia-Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.,Division of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,BDbiomed, Big & Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.,Division of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
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Mao Y, He M, Tang Z, Chen M, Wu L, Liang T, Huang J. Prognostic nomograms to predict overall survival and cause specific death in vulvar squamous cell carcinoma. Int J Gynecol Cancer 2022; 32:706-715. [DOI: 10.1136/ijgc-2021-003211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe incidence of vulvar squamous cell carcinoma has been rising in recent decades. The prognosis of patients with vulvar squamous cell carcinoma was explored, and nomograms were constructed to predict survival rates.MethodsVulvar squamous cell carcinoma patient data were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into a training dataset and testing dataset. Univariable and multivariable Cox regression were used to identify risk factors affecting vulvar squamous cell carcinoma overall survival in the training dataset. Cumulative incidence function and Fine–Gray regression were used to analyze cancer specific death in the training dataset. Overall survival and cancer specific death nomograms were constructed and validated in the testing and whole datasets. Receiver operating characteristic and calibration were used to verify the predictive value and clinical applicability of the models.ResultsAge ≥60 years, grade 3, American Joint Committee on Cancer stages III and IV, TNM (tumor, nodes, metastasis) stages T2, T3, N1, and M1 had a negative effect on overall survival in vulvar cancer patients. Surgery (hazard ratio (HR)=0.416, 95% confidence interval (CI) 0.349 to 0.496, p<0.001) and chemotherapy (HR=0.637, 95% CI 0.544 to 0.746, p<0.001) may improve overall survival. Age, tumor grade, American Joint Committee on Cancer stage, T stage, N stage, M stage, surgery, and chemotherapy significantly affected vulvar cancer specific death. For area under the receiver operating characteristic curve, the predictive ability of the nomograms for overall survival and cancer specific death for 1 year (area under the curve (AUC)=0.862), 3 years (AUC=0.832), and 5 years (AUC=0.808) were all >0.800.ConclusionThe nomograms established in our study had an excellent predictive ability for overall survival and cancer specific death in vulvar cancer patients.
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9
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Lorenzini J, Deberti M, Body G, Carcopino X, Touboul C, Dabi Y, Collinet P, Coutant C, Akladios C, Lavoué V, Bolze PA, Huchon C, Bricou A, Canlorbe G, Mimoun C, Bendifallah S, Ouldamer L. Lymphovascular space invasion and Estrogen Receptor status in high-grade serous ovarian cancer-a multicenter study by the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2021; 51:102242. [PMID: 34715402 DOI: 10.1016/j.jogoh.2021.102242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of Lymphovascular Space Invasion (LVSI) on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for high-grade serous epithelial ovarian cancer (HGSOC). MATERIALS AND METHODS Retrospective multicenter study by the FRANCOGYN research group between January 2001 and December 2018. All patients managed for HGSOC and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A Cox analysis for OS and RFS analysis was performed in all populations. RESULTS Over the study period, 410 patients were included in the thirteen institutions. Among them, 289 patients had LVSI (33.9%). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p<0.001) and RFS (p<0.001), Association of LVSI status and estrogen receptor status (ER) also affected OS and RFS (p=0.04; p=0.04 respectively). CONCLUSION The presence of LVSI in HGSOC has an impact on OS and RFS and should be routinely included in the pathology examination along with ER status.
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Affiliation(s)
- Jerome Lorenzini
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France
| | - Marion Deberti
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France
| | - Gilles Body
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France; INSERM U1069 Université François-Rabelais, Tours, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Creteil, France
| | - Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Creteil, France
| | - Pierre Collinet
- Department of Gynecologic surgery, Jeanne de Flandre Hospital, CHRU LILLE, Rue Eugene Avinée 59037 Lille Cedex, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Centre, Dijon, France
| | - Cherif Akladios
- Department of Surgical Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Lavoué
- Department of Gynecology, Rennes University Hospital, France. INSERM 1242, COSS, Rennes. Université de Rennes 1. France
| | - Pierre-Adrien Bolze
- Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, France
| | - Cyrille Huchon
- Department of gynecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, Versailles, France
| | - Alexandre Bricou
- Department of Gynecology, Bobigny University, AP-HP, Jean-Verdier Hospital, Bondy, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière, University Hospital, Paris, France
| | - Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, 750019 Paris, France
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Lobna Ouldamer
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France; INSERM U1069 Université François-Rabelais, Tours, France.
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Lymphovascular invasion as a criterion for adjuvant chemotherapy for FIGO stage I-IIa clear cell carcinoma, mucinous, low grade serous and low grade endometrioid ovarian cancer. J Gynecol Obstet Hum Reprod 2021; 50:102193. [PMID: 34224900 DOI: 10.1016/j.jogoh.2021.102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of lymphovascular space invasion (LVSI) on overall survival (OS) and recurrence-free survival (RFS) in patients managed for stage I-IIa clear cell carcinoma, mucinous, low-grade serous and low-grade endometrioid ovarian cancer MATERIAL AND METHODS: Retrospective multicentre study of the research group FRANCOGYN between January 2001 and December 2018. All patients managed for stage I-IIa clear cell carcinoma, mucinous /low grade serous and endometrioid ovarian cancer and for whom the presence of histological slides for the review of LVSI was available, were included. Patient's characteristics with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A cox analysis for OS and RFS analysis were performed in all population. RESULTS Over the study period, 133 patients were included in the thirteen institutions. Among them, 12 patients had LVSI (9%). LVSI was an independent predictive factor for poorer Overall and recurrence free survivals. LVSI affected OS (p < 0.001) and RFS (p = 0.0007), CONCLUSION: The presence of LVSI in stage I-IIa clear cell carcinoma, mucinous /low grade serous and endometrioid ovarian cancer has an impact on OS and RFS and should put them at high risk and consider the option of adjuvant chemotherapy.
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Zach D, Åvall-Lundqvist E, Falconer H, Hellman K, Johansson H, Flöter Rådestad A. Patterns of recurrence and survival in vulvar cancer: A nationwide population-based study. Gynecol Oncol 2021; 161:748-754. [PMID: 33736857 DOI: 10.1016/j.ygyno.2021.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the patterns of recurrence and how these patterns are associated with survival in vulvar squamous cell carcinoma. We also explored the survival impact of surgical groin staging (SGS). METHODS Nationwide population-based study including women diagnosed with vulvar squamous cell carcinoma between 2012 and 2015 and registered in the Swedish Quality Registry for Gynecologic Cancer. Cumulative incidence rates (CIR), recurrence-free (RFS) and overall survival (OS) were calculated by Kaplan Meier estimates. The impact of SGS on RFS and OS was analyzed by proportional hazards models. RESULTS 489 eligible women were included. Median follow-up time was 64 months. The overall recurrence rate was 22.3%. Site of recurrence: local in 61.0%, groin in 30.0%, distant in 9.0%. The CIR for local recurrences increased with time (5.9% at 2-years, 14.7% at 5-years) while the rate of groin and distant recurrences was nearly steady (5.5% to 6.3% and 1.5% to 1.7%, respectively). Median 2-year and 4-year OS post-recurrence was 57.8% and 37.4% for local, 17.2%, 10.3% for groin and 0% for distant recurrences, respectively. SGS was omitted in 23.7% of surgically treated women with FIGO stages IB-II and significantly associated with worse RFS (Hazard ratio, HR, 1.9; 95%CI, 1.0-3.5; p = 0.04) and OS (HR 2.0; 95%CI, 1.1-3.8; p = 0.04) after adjustment for age, FIGO stage, tumor size, resection margins and performance status. CONCLUSION The cumulative incidence of isolated vulvar recurrence was low but for those affected the prognosis was poor. Surgical groin staging is a crucial part of primary treatment and should not be omitted.
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Affiliation(s)
- Diana Zach
- Dept of Gynecological Cancer, Karolinska University Hospital, Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
| | - Elisabeth Åvall-Lundqvist
- Dept of Oncology and Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Falconer
- Dept of Gynecological Cancer, Karolinska University Hospital, Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Kristina Hellman
- Dept of Gynecological Cancer, Karolinska University Hospital, Dept of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Hemming Johansson
- Dept of Gynecological Cancer, Karolinska University Hospital, Dept of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Angelique Flöter Rådestad
- Dept of Hereditary Cancer, Karolinska University Hospital, Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Lymph node extracapsular extension as a marker of aggressive phenotype: Classification, prognosis and associated molecular biomarkers. Eur J Surg Oncol 2021; 47:721-731. [DOI: 10.1016/j.ejso.2020.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
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Preti M, Bucchi L, Micheletti L, Privitera S, Corazza M, Cosma S, Gallio N, Borghi A, Bevilacqua F, Benedetto C. Four-decade trends in lymph node status of patients with vulvar squamous cell carcinoma in northern Italy. Sci Rep 2021; 11:5661. [PMID: 33707570 PMCID: PMC7952703 DOI: 10.1038/s41598-021-85030-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/16/2021] [Indexed: 01/25/2023] Open
Abstract
The 4-decade (1980-2017) trends in lymph node status of patients with vulvar squamous cell carcinoma (VSCC) in a province of northern Italy were investigated. Information was collected on lymph node dissection, number of lymph nodes dissected, lymph node involvement, and number of positive lymph nodes from a series of 760 patients admitted to a tertiary referral centre for vulvar disease. The adjusted odds ratios (ORs) for lymph node involvement, for ≥ 2 positive nodes, and for a lymph node ratio ≥ 20% were estimated from multiple logistic regression models. The adjusted OR for lymph node dissection was greater in the 2000s and 2010s versus the 1980s. The adjusted OR for lymph node involvement was 1.36 (95% confidence interval (CI), 0.72-2.60) in the 1990s, 1.31 (95% CI, 0.72-2.38) in the 2000s and 1.32 (95% CI, 0.73-2.41) in the 2010s versus the 1980s. The adjusted OR for ≥ 2 positive nodes was 1.36 (95% CI, 0.68-2.72), 0.86 (95% CI, 0.44-1.65) and 0.67 (95% CI, 0.34-1.31), respectively. The adjusted OR for lymph node ratio ≥ 20% was 1.45 (95% CI, 0.62-3.43), 1.21 (95% CI, 0.54-2.72) and 0.81 (95% CI, 0.35-1.89), respectively. This stagnation indicates the need for a serious rethink of the local model for the care of VSCC.
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Affiliation(s)
- Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy.
| | | | - Silvana Privitera
- Department of Pathology, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, Torino, Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - Stefano Cosma
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | | | - Chiara Benedetto
- Department of Surgical Sciences, University of Torino, Torino, Italy
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Miljanović-Špika I, Madunić MD, Topolovec Z, Kujadin Kenjereš D, Vidosavljević D. PROGNOSTIC FACTORS FOR VULVAR CANCER. Acta Clin Croat 2021; 60:25-32. [PMID: 34588718 PMCID: PMC8305353 DOI: 10.20471/acc.2021.60.01.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022] Open
Abstract
The aim of this retrospective study was to show the effect of clinical, pathologic, cytologic and therapeutic prognostic factors on treatment outcome and survival of patients suffering from vulvar cancer and to determine prognostic significance of each of the individual factors, their mutual significance and impact on survival. The study included patients treated for vulvar cancer at Department of Gynecology and Obstetrics, Osijek University Hospital Centre during the 2000-2011 period. Retrospective analysis included data from patient medical files, along with their pathologic and cytologic findings, and oncologist findings. The study included 59 patients aged 45 to 88 years. Diagnosis was based on pathologic and cytologic status and staging. Univariate analysis showed the lymph node status, adjuvant radiotherapy, chemotherapy and clinical staging of the disease to be statistically significant prognostic factors for overall survival and prognosis of vulvar cancer patients. Multivariate analysis of independent prognostic factors for survival of vulvar cancer patients yielded lymph node status, adjuvant radiotherapy and chemotherapy as positive prognostic factors.
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Affiliation(s)
| | - Maja Drežnjak Madunić
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Center, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of Internal Medicine, Vukovar General Hospital, Vukovar, Croatia
| | - Zlatko Topolovec
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Center, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of Internal Medicine, Vukovar General Hospital, Vukovar, Croatia
| | - Dajana Kujadin Kenjereš
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Center, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of Internal Medicine, Vukovar General Hospital, Vukovar, Croatia
| | - Domagoj Vidosavljević
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Center, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of Internal Medicine, Vukovar General Hospital, Vukovar, Croatia
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Zapardiel I, Iacoponi S, Coronado PJ, Zalewski K, Chen F, Fotopoulou C, Dursun P, Kotsopoulos IC, Jach R, Buda A, Martinez-Serrano MJ, Grimm C, Fruscio R, Garcia E, Sznurkowski JJ, Ruiz C, Noya MC, Barazi D, Diez J, Diaz De la Noval B, Bartusevicius A, De Iaco P, Otero M, Diaz M, Haidopoulos D, Franco S, Blecharz P, Zuñiga MA, Rubio P, Gardella B, Papatheodorou DC, Yildirim Y, Fargas F, Macuks R. Prognostic factors in patients with vulvar cancer: the VULCAN study. Int J Gynecol Cancer 2020; 30:1285-1291. [PMID: 32571891 DOI: 10.1136/ijgc-2019-000526] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/29/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer. METHODS This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed. RESULTS After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget's disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05). CONCLUSIONS Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.
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Affiliation(s)
- Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Sara Iacoponi
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Pluvio J Coronado
- Gynecology Department, Hospital Clinico Universitario San Carlos - IdISSC, Madrid, Spain
| | - Kamil Zalewski
- Gynecologic Oncology Department, Maria Sklodowska-Curie Memorial Cancer Center - Institute of Oncology, Warsaw, Poland
| | - Frank Chen
- Department of Gynecology, Campus Virchow-Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Christina Fotopoulou
- Department of Gynecology, Campus Virchow-Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Polat Dursun
- Department of Obstetrics and Gynecology Division of Gynecologic Oncology, Baskent University School of Medicine, Ankara, Turkey
| | | | - Robert Jach
- Gynecology Department, University Hospital, Jagiellonian University, Krakow, Poland
| | - Alessandro Buda
- Gynecologic Oncology Department, Hospital San Gerardo, Monza, Lombardia, Italy
| | | | - Christoph Grimm
- Division of General Gynaecology and Gynaecological Oncology, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Robert Fruscio
- Gynecologic Oncology Department, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Enrique Garcia
- Gynecologic Oncology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Cristina Ruiz
- Gynecologic Oncology Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Maria C Noya
- Gynecology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Dib Barazi
- Gynecologic Oncology Department, Ciudad Sanitaria de Bellvitge, Barcelona, Spain
| | - Javier Diez
- Gynecologic Oncology Department, Hospital de Cruces, Vizcaya, Spain
| | | | - Arnoldas Bartusevicius
- Gynecologic Oncology Department, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | | | - Maria Otero
- Gynecology Department, Complejo Hospitalario de Leon, Leon, Spain
| | - Maria Diaz
- Gynecology Department, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, Spain
| | | | - Silvia Franco
- Gynecology Department, Hospital Vall D'Hebron, Barcelona, Spain
| | - Pawel Blecharz
- Gynecologic Oncology Department, Maria Sklodowska-Curie Memorial Cancer Center, Krakow, Poland
| | - Miguel A Zuñiga
- Gynecology Department, Complejo Hospitalario Torrecardenas, Almeria, Spain
| | - Patricia Rubio
- Gynecology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Barbara Gardella
- Gynecologic Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Yusuf Yildirim
- Gynecologic Oncology Department, Ege Gynaecology Training and Research Hospital, Izmir, Turkey
| | - Francesc Fargas
- Gynecology Department, Instituto Universitario Dexeus, Barcelona, Spain
| | - Ronalds Macuks
- Gynecologic Oncology Department, Riga East Clinical University Hospital Latvian Oncology Center, Riga, Latvia
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Pirot F, Chaltiel D, Ouldamer L, Touboul C, Raimond E, Carcopino X, Daraï E, Bendifallah S. Patterns of first recurrence and outcomes in surgically treated women with vulvar cancer: results from FRANCOGYN study group. J Gynecol Obstet Hum Reprod 2020; 49:101775. [PMID: 32438137 DOI: 10.1016/j.jogoh.2020.101775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cancer of the vulva recurrences vary considerably over time and are influenced by several pathological, surgical and adjuvant therapeutic prognostic factors. However, limited information is available about patterns of disease recurrence and prognosis. We analysed patterns of vulvar cancer recurrence based on a large French multicentre database. METHODS Data of women with histologically proven squamous cell carcinoma (SCC) and other vulvar cancer treated between 1976 and 2016 were retrospectively abstracted from five institutions with prospectively maintained vulvar cancer databases in France. The endpoints were pattern of recurrence, recurrence free survival (RFS) and overall survival (OS). Time to the first recurrence in a specific site was evaluated by using cumulative incidence analysis (Gray's test) and competing risks regression analysis to estimate sub-distribution hazard ratios and 95% CIs. RESULTS In the whole population, recurrences were observed in 188 of the 617 women (30%) with local-regional, distant and multifocal recurrences in 18% (109/617), 3% (17/617), 10% (62/617), respectively. The median time to recurrence with Interquartile Range (IQR) was 13 months IQR [8-30]. The overall respective 3-years OS and RFS were 78.5% (IC95%: 74.5-82.5) and 75.5% (IC95%: 71.1-80.0). According to FIGO stage, lymph node status and positive lympho-vascular invasion (LVSI), pattern and time of loco-regional and distant recurrence were significantly different. There wasn't interaction between FIGO stage and LVSI in OS neither RFS (p=0.08 and 0.9 respectively). CONCLUSION AND DISCUSSION We report specific time and site patterns of first recurrence according to FIGO stage, lymph node status and lymphovascular invasion status. Positive LVSI is an important and independent prognostic factor. Defining patterns of recurrence may provide useful information for developing follow-up recommendations and designing therapeutic approaches.
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Affiliation(s)
- Florie Pirot
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France.
| | - Dan Chaltiel
- INSERM U1018, CESP, Fac. de Médecine-Univ. Paris-Sud-UVSQ, INSERM, Université Paris-Saclay, 94807 Villejuif cedex, France
| | - Lobna Ouldamer
- Gustave Roussy, Service de Biostatistique et d'Epidémiologie, Villejuif F-94805, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Centre hospitalier régional universitaire de Marseille, hôpital Nord, Marseille, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France
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Prognostic value of lymph node ratio in surgically treated cases of vulvar cancer: a tertiary care centre experience. Obstet Gynecol Sci 2020; 63:158-163. [PMID: 32206655 PMCID: PMC7073358 DOI: 10.5468/ogs.2020.63.2.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 11/08/2022] Open
Abstract
Objective This study aimed to study the patterns of recurrence in surgically treated cases of vulvar cancer (VC) and determine the factors associated with recurrence, with a special emphasis on lymph node ratio (LNR). Methods This retrospective study examined VC patients primarily treated with surgery at our institute from January 2005 to December 2015. Demographic data, clinical characteristics, surgicohistopathological data, adjuvant treatment, follow up, and recurrence site and treatment were studied. Results Among the 111 cases treated, a recurrence rate of 18.9% was noted. Recurrence was most commonly local (61.9%). On univariate and multivariable analyses of clinicopathological parameters, an LNR >20 had the highest hazard ratio for recurrence. Conclusion LNR may provide useful prognostic information in VC patients with positive inguinal lymph node status.
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Dahbi Z, Elmejjatti F, Naciri F, Guerouaz A, Oabdelmoumen A, Sbai A, Mezouar L. [Vulvar cancer treatment options: experience in the Oncology Center in Oujda]. Pan Afr Med J 2019; 31:182. [PMID: 31086633 PMCID: PMC6488234 DOI: 10.11604/pamj.2018.31.182.13812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/01/2018] [Indexed: 11/23/2022] Open
Abstract
Le cancer de la vulve est une affection néoplasique rare, représentant moins de 5% des cancers génitaux de la femme. L'objectif de ce travail est de décrire le profil épidémiologique, clinique, paraclinique, thérapeutique et évolutif du cancer de la vulve chez la population de la région de l'Oriental du Maroc, ceci à travers une analyse rétrospective de toutes les patientes suivies pour un cancer de la vulve, de juin 2007 à janvier 2014, et traitées au sein de l'hôpital d'Oncologie du Centre Hospitalier Universitaire Mohamed VI de Oujda au Maroc. Notre analyse rétrospective a porté sur 34 patientes, d'une médiane d'âge de 65,7 ans, dont 52,9% étaient des multipares. Le motif de consultation dominant était le prurit dans 94.1% des cas. La moyenne du délai de consultation était de 16 mois, allant de 2 mois à 8 ans. L'ignorance et la pudeur ont été les causes majeures de ce retard diagnostique, puisque 73.5% des patientes avaient déjà une maladie localement avancée au diagnostic. Le traitement chirurgical a été proposé à 61.4% des cas, il a consisté en une vulvectomie radicale avec un curage inguinal bilatéral dans 68.5% des cas. Le recours à la radiothérapie adjuvante a été indiqué chez 41.2% des cas, 5.9% des patientes ont bénéficié d'une radiothérapie néo adjuvante, et 20,6% d'une radiothérapie exclusive associée à une chimiothérapie concomitante. La chimiothérapie palliative a été proposée pour 8.8% des patientes. Le taux de survie globale à 3 ans est à 65%, le taux de récidives locorégionales ou à distance est de 17.3% des cas. Les particularités culturelles et sociales des patientes de la région de l'Oriental du Maroc, qui sont suivies pour un cancer de la vulve, sont des facteurs influençant le traitement et ses résultats. Des efforts de prévention et de sensibilisation supplémentaires sont à mener afin de réduire l'incidence des stades localement avancés, et de permettre un traitement curatif à cette population.
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Affiliation(s)
- Zineb Dahbi
- Service de Radiothérapie, Centre Hospitalier Universitaire d'Oujda, Oujda, Maroc
| | - Fouad Elmejjatti
- Service de Radiothérapie, Centre Hospitalier Universitaire d'Oujda, Oujda, Maroc
| | - Farid Naciri
- Service de Radiothérapie, Centre Hospitalier Universitaire d'Oujda, Oujda, Maroc
| | - Amine Guerouaz
- Service de Radiothérapie, Centre Hospitalier Universitaire d'Oujda, Oujda, Maroc
| | - Asmae Oabdelmoumen
- Service de Radiothérapie, Centre Hospitalier Universitaire d'Oujda, Oujda, Maroc
| | - Ali Sbai
- Service de Radiothérapie, Centre Hospitalier Universitaire d'Oujda, Oujda, Maroc
| | - Loubna Mezouar
- Service de Radiothérapie, Centre Hospitalier Universitaire d'Oujda, Oujda, Maroc
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Long Y, Yao DS, Wei YS, Wei CH, Chen XY. Prognostic significance of perineural invasion in vulvar squamous cell carcinoma. Cancer Manag Res 2019; 11:4461-4469. [PMID: 31191008 PMCID: PMC6525828 DOI: 10.2147/cmar.s198047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/10/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Perineural invasion (PNI) is closely associated with poor survival in several types of malignant tumours, but whether this is true in vulvar squamous cell carcinoma (VSCC) is unclear. The aims of this study were to determine the prognostic significance of PNI in patients with VSCC. Patients and methods: We retrospectively analysed clinico-pathological data on 105 patients with VSCC (stages IB-IV) treated surgically at our medical center between 2005 and 2015. Results: PNI was detected in 30 (28.6%) patients, and it was significantly associated with well-known clinical risk factors: large tumour size, depth of invasion, lymphatic vascular space invasion (LVSI), and intra- or extra-nodal spread. Significantly greater proportions of patients with PNI received adjuvant therapy after surgery (P=0.001) or showed local recurrence (P=0.002). Multivariable analysis indicated that risk factors for disease-free survival were tumour size (HR 3.02, 95%CI 1.75-7.75), LVSI (HR 4.82, 95%CI 1.36-17.07), depth of invasion (HR 3.11, 95%CI 1.50-6.44), lymph node metastasis (HR 3.15, 95%CI 1.14-8.96) and positive or close surgical margins (HR 4.86, 95%CI 1.67-14.19). The latter three variables were also risk factors for overall survival. PNI was associated with significantly shorter disease-free survival (DFS) (P=0.020) and overall survival (OS) (P=0.017) based on the log-rank test. Among patients who received adjuvant treatment, Kaplan-Meier curves indicated no significant differences between PNI-positive or -negative subgroups in disease-free survival (P=0.085) or overall survival (P=0.061). Based on multivariable analysis of all patients, PNI was not a significant risk factor for either type of survival . Conclusion: PNI in VSCC is associated with significantly shorter disease-free and overall survival, though it appears to be a weak independent predictor of worse prognosis. Combining PNI with other risk factors may be useful for predicting whether postoperative adjuvant therapy will be needed.
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Affiliation(s)
- Ying Long
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People's Republic of China
| | - De-Sheng Yao
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People's Republic of China
| | - You-Sheng Wei
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People's Republic of China
| | - Chang-Hong Wei
- Department of Pathology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People's Republic of China
| | - Xiao-Yu Chen
- Department of Pathology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People's Republic of China
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Thangarajah F, Morgenstern B, Pahmeyer C, Schiffmann LM, Puppe J, Mallmann P, Hamacher S, Buettner R, Alidousty C, Holz B, Scheel AH, Schultheis AM. Clinical impact of PD-L1 and PD-1 expression in squamous cell cancer of the vulva. J Cancer Res Clin Oncol 2019; 145:1651-1660. [PMID: 30972492 DOI: 10.1007/s00432-019-02915-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/08/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Squamous cell carcinoma of the vulva (SQCV) is the fifth most common cancer in women and accounts for about 5% of all genital cancers in women. The PD-L1 signaling pathway is activated in many malignant neoplasms and its blockade enhances anti-cancer immunity. The aim of our study was to examine the protein expression of PD-L1 and PD-1 in squamous cell cancer of the vulva, its correlations with clinicopathologic features and prognostic value. METHODS Patients with SQCV treated in one institution were used for the analyses. PD-L1 immunohistochemistry was performed on 4 µm-thick section of the respective FFPE tissue blocks using the 28-8 antibody. PD-L1 scoring was performed separately for tumour cells (TC) and tumour associated immune cells. DNA was extracted to determine HPV status. Kaplan-Meier estimates for disease-free-survival and overall-survival were calculated and compared by log-rank test. RESULTS PD-L1 expression in tumour cells could be observed in 32.9% of the patients. The expression of PD-L1 in peritumoural immune cells was confirmed in 91.4% of the patients. A significant correlation between PD-L1 expression in tumour cells and tumour stage was detected (p = 0.007). PD-L1 expression was independent from HPV status. Using the log-rank test we could not prove any significant differences in disease-free survival (p = 0.434) and overall survival (p = 0.858). Regression analysis showed that nodal status is a predictive factor of survival (p < 0.001). CONCLUSION The present study showed that a relevant amount of patients with squamous cell cancer of the vulva express PD-L1 in both, tumour cells and tumour-associated immune cells. Furthermore, the significant correlation of PD-L1 expression in TCs with tumour stage indicated the clinical impact of PD-L1 expression during tumour development. These data indicate that SQCV might be amenable to immune checkpoint-inhibition and constitute a rational for the future clinical trials.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
| | - Bernd Morgenstern
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Caroline Pahmeyer
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Lars Mortimer Schiffmann
- Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Julian Puppe
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Reinhard Buettner
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany
| | - Christina Alidousty
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany
| | - Barbara Holz
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany
| | - Andreas H Scheel
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anne Maria Schultheis
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany.
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21
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Jeevarajan S, Duraipandian A, Kottayasamy Seenivasagam R, Shanmugam S, Ramamurthy R. Treatment Outcome of Carcinoma Vulva Ten-Year Experience from a Tertiary Cancer Centre in South India. Int J Surg Oncol 2017; 2017:7161437. [PMID: 29387486 PMCID: PMC5745700 DOI: 10.1155/2017/7161437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 10/15/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Carcinoma vulva is a rare disease accounting for 1.3% of all gynaecological malignancies. The present study is a 10-year retrospective review of our experience of the surgical options, morbidity, failure pattern, and survival for invasive carcinoma vulva. MATERIALS AND METHODS Retrospective analysis of case records of 39 patients who underwent surgery for invasive vulval cancer between 2004 and 2013 in the Department of Surgical Oncology at the Government Royapettah Hospital, Chennai. RESULTS The median age was 55 years. Radical vulvectomy was the preferred surgery. 31 patients underwent lymphadenectomy. Seroma formation and groin skin necrosis were the most common postoperative complications. With a median follow-up of 32 months, 8 patients (20.5%) developed recurrence (systemic = 1, regional = 4, and local = 3). The estimated 5-year disease-free survival (DFS) was 65.4% and the overall survival (OS) was 85.1%. On univariate analysis, stage and lymph node involvement significantly affected OS. Nodal involvement with extracapsular spread (ECS) significantly affected both DFS and OS. CONCLUSION The treatment of carcinoma vulva should be individualized with multidisciplinary cooperation. The paucity of data, especially from India, necessitates the need for more studies, preferably multicentric, keeping in mind the low prevalence.
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Affiliation(s)
- Sakthiushadevi Jeevarajan
- Department of Surgical Oncology, Tamil Nadu Multi-Super Specialty Hospital, Chennai, Tamil Nadu, India
| | - Amudhan Duraipandian
- Department of Surgical Oncology, Thoothukudi Medical College, Thoothukudi, Tamil Nadu, India
| | - Rajkumar Kottayasamy Seenivasagam
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
- Department of Surgical Oncology, Coimbatore Medical College & Hospital, Coimbatore, Tamil Nadu, India
| | - Subbiah Shanmugam
- Department of Surgical Oncology, Government Royapettah Hospital and Kilpauk Medical College, Chennai, India
| | - Rajaraman Ramamurthy
- Department of Surgical Oncology, Government Royapettah Hospital and Kilpauk Medical College, Chennai, India
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Laliscia C, Fabrini MG, Cafaro I, Barcellini A, Baldaccini D, Miniati M, Parietti E, Morganti R, Paiar F, Gadducci A. Adjuvant Radiotherapy in High-Risk Squamous Cell Carcinoma of the Vulva: A Two-Institutional Italian Experience. Oncol Res Treat 2017; 40:778-783. [PMID: 29183034 DOI: 10.1159/000479876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the treatment benefit and patterns of recurrence for patients with high-risk vulvar squamous cell carcinoma treated with surgery followed by adjuvant radiotherapy (RT). PATIENTS AND METHODS From January 1999 to June 2016, 51 patients underwent total or partial deep vulvectomy with inguinofemoral lymphadenectomy followed by adjuvant RT with 45-50 Gy in 25 fractions +/- a 4-10 Gy boost. 17 (33.3%) women received concomitant chemotherapy. RESULTS Median overall survival was 81 months. The 5-year disease-free survival and overall survival rates were 52 and 63%, respectively. In univariate and multivariate analysis, patients aged ≤ 76 years and those receiving an RT total dose of > 54 Gy had a significantly lower risk of progression (p = 0.044 and 0.045; p = 0.012 and 0.018, respectively) and death (p = 0.015 and 0.011; p = 0.015 and 0.026, respectively). There was a trend towards a lower risk of progression for patients with tumor size ≤ 4 (p = 0.098) and negative lymphovascular space involvement (p = 0.080). Also, there was a trend towards a higher risk of death (p = 0.075) for grade 3 tumors. Concomitant chemotherapy provided no significant benefit. CONCLUSION Only age and RT total dose are significant prognostic variables for squamous cell carcinoma of the vulva treated with primary surgery and adjuvant RT to improve local and locoregional control.
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Affiliation(s)
- Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
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23
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Matsuo K, Wong KK, Fotopoulou C, Blake EA, Robertson SE, Pejovic T, Frimer M, Pardeshi V, Hu W, Choi JS, Sun CC, Richmond AM, Marcus JZ, Hilliard MAM, Mostofizadeh S, Mhawech-Fauceglia P, Abdulfatah E, Post MD, Saglam O, Shahzad MMK, Karabakhtsian RG, Ali-Fehmi R, Gabra H, Roman LD, Sood AK, Gershenson DM. Impact of lympho-vascular space invasion on tumor characteristics and survival outcome of women with low-grade serous ovarian carcinoma. J Surg Oncol 2017; 117:236-244. [PMID: 28787528 DOI: 10.1002/jso.24801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine association of lympho-vascular space invasion (LVSI) with clinico-pathological factors and to evaluate survival of women with low-grade serous ovarian carcinoma containing areas of LVSI. METHODS This is a multicenter retrospective study examining consecutive cases of surgically treated stage I-IV low-grade serous ovarian carcinoma (n = 178). Archived histopathology slides for the ovarian tumors were reviewed, and LVSI was scored as present or absent. LVSI status was correlated to clinico-pathological findings and survival outcome. RESULTS LVSI was seen in 79 cases (44.4%, 95% confidence interval [CI] 37.1-51.7). LVSI was associated with increased risk of omental metastasis (87.0% vs 64.9%, odds ratio [OR] 3.62, P = 0.001), high pelvic lymph node ratio (median 12.9% vs 0%, P = 0.012), and malignant ascites (49.3% vs 32.6%, OR 2.01, P = 0.035). On multivariable analysis, controlling for age, stage, and cytoreductive status, presence of LVSI in the ovarian tumor remained an independent predictor for decreased progression-free survival (5-year rates 21.0% vs 35.7%, adjusted-hazard ratio 1.57, 95%CI 1.06-2.34, P = 0.026). LVSI was significantly associated with increased risk of recurrence in lymph nodes (OR 2.62, 95%CI 1.08-6.35, P = 0.047). CONCLUSION LVSI in the ovarian tumor is associated with adverse clinico-pathological characteristics and decreased progression-free survival in women with low-grade serous ovarian carcinoma.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kwong-Kwok Wong
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Christina Fotopoulou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colarodo
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Sharon E Robertson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Tanja Pejovic
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Marina Frimer
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vishakha Pardeshi
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Wei Hu
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jong-Sun Choi
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Charlotte C Sun
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Abby M Richmond
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jenna Z Marcus
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maren A M Hilliard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Sayedamin Mostofizadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Paulette Mhawech-Fauceglia
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Eman Abdulfatah
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Miriam D Post
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Ozlen Saglam
- Department of Pathology, University of Southern California, Los Angeles, California
| | - Mian M K Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Rouzan G Karabakhtsian
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Rouba Ali-Fehmi
- Clinical Discovery Unit, Early Clinical Development, AstraZeneca, Cambridge, UK
| | - Hani Gabra
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colarodo
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anil K Sood
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - David M Gershenson
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Predictors and Patterns of Local, Regional, and Distant Failure in Squamous Cell Carcinoma of the Vulva. Am J Clin Oncol 2017; 40:235-240. [PMID: 25503429 DOI: 10.1097/coc.0000000000000138] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Rao YJ, Hassanzadeh C, Chundury A, Hui C, Siegel BA, Dehdashti F, DeWees T, Mullen D, Powell MA, Mutch DG, Schwarz JK, Grigsby PW. Association of post-treatment positron emission tomography with locoregional control and survival after radiation therapy for squamous cell carcinoma of the vulva. Radiother Oncol 2017; 122:445-451. [DOI: 10.1016/j.radonc.2016.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/12/2016] [Accepted: 12/18/2016] [Indexed: 12/18/2022]
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26
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Batra Modi K, Sekhon R, Shah S, Giri S, Jain V, Mitra S, Rawal S. Recurrent Cancer of the Vulva: Clinicopathologic Prognostic Factors, Patterns of Recurrence, and Their Management. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kanika Batra Modi
- Department of Uro-Gynaecolgic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rupinder Sekhon
- Department of Uro-Gynaecolgic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Swati Shah
- Department of Uro-Gynaecolgic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Shweta Giri
- Department of Uro-Gynaecolgic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vandana Jain
- Department of Uro-Gynaecolgic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Swarupa Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sudhir Rawal
- Department of Uro-Gynaecolgic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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27
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Schnürch HG, Ackermann S, Alt CD, Barinoff J, Böing C, Dannecker C, Gieseking F, Günthert A, Hantschmann P, Horn LC, Kürzl R, Mallmann P, Marnitz S, Mehlhorn G, Hack CC, Koch MC, Torsten U, Weikel W, Wölber L, Hampl M. 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; 76:1035-1049. [PMID: 27765958 DOI: 10.1055/s-0042-103728] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: This is an official guideline, published and coordinated by the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Study Group for Gynecologic Oncology) of the Deutsche Krebsgesellschaft (DKG, German Cancer Society) and the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG, German Society for Gynecology and Obstetrics). The number of cases with vulvar cancer is on the rise, but because of the former rarity of this condition and the resulting lack of literature with a high level of evidence, in many areas knowledge of the optimal clinical management still lags behind what would be required. This updated guideline aims to disseminate the most recent recommendations, which are much clearer and more individualized, and is intended to create a basis for the assessment and improvement of quality care in hospitals. Methods: This S2k guideline was drafted by members of the AGO Committee on Vulvar and Vaginal Tumors; it was developed and formally completed in accordance with the structured consensus process of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Recommendations: 1. The incidence of disease must be taken into consideration. 2. The diagnostic pathway, which is determined by the initial findings, must be followed. 3. The clinical and therapeutic management of vulvar cancer must be done on an individual basis and depends on the stage of disease. 4. The indications for sentinel lymph node biopsy must be evaluated very carefully. 5. Follow-up and treatment for recurrence must be adapted to the individual case.
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Affiliation(s)
| | | | - C D Alt
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf
| | - J Barinoff
- Klinik für Gynäkologie und Geburtshilfe, Markus Krankenhaus, Frankfurt am Main
| | - C Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen
| | - C Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität München, Campus Großhadern, München, Munich
| | - F Gieseking
- Dysplasiezentrum in der Frauenarztpraxis Heussweg, Hamburg
| | - A Günthert
- Frauenklinik Luzerner Kantonsspital, Lucerne, Switzerland
| | - P Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting
| | - L C Horn
- Institut für Pathologie des Universitätsklinikums Leipzig, Leipzig
| | - R Kürzl
- ehem. Universitätsfrauenklinik Maistraße, Munich
| | - P Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität Köln, Cologne
| | - S Marnitz
- Klinik und Poliklinik für Radioonkologie und Strahlentherapie der Universität Köln, Cologne
| | - G Mehlhorn
- Universitätsfrauenklinik Erlangen, Erlangen
| | - C C Hack
- Universitätsfrauenklinik Erlangen, Erlangen
| | - M C Koch
- Universitätsfrauenklinik Erlangen, Erlangen
| | - U Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin
| | - W Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz
| | - L Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M Hampl
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf, Düsseldorf
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Treatment Results and Prognostic Factors of Patients with Vulvar Cancer Treated with Postoperative or Definitive Radiotherapy. TUMORI JOURNAL 2016; 2016:311-5. [DOI: 10.5301/tj.5000509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 11/20/2022]
Abstract
Purpose Vulvar cancer is a relatively uncommon type of gynecologic cancer. The aim of this study is to analyze the treatment results and prognostic factors of vulvar cancer. Methods Forty-four vulvar cancer patients treated between 2000 and 2011 at the Department of Radiation Oncology, Ege University Faculty of Medicine, were retrospectively reviewed. External radiotherapy (RT) was applied with 6-18 MV linear accelerators with 1.8 Gy daily fractions with a median total dose of 50.4 Gy (45-59.4 Gy) for postoperative cases and 64.8 Gy (range 54-66 Gy) for definitive cases. Statistical analyses were performed with SPSS 13.0. Results Among 44 patients with a median age of 68 years (range 28-86), 14 (31.8%) were treated with curative and 30 (68.2%) were treated with postoperative RT or radiochemotherapy (RCT). According to International Federation of Gynecology and Obstetrics staging, 11 (25%) had stage IB, 10 (22.7%) had stage II, 6 (13.6%) had stage IIIA, 5 (11.4%) had stage IIIB, and 12 (27.3%) had stage IVA disease. Within a median of 24 months (range 6-135) of follow-up, 11 (27.3%) patients had local recurrence, 8 had regional recurrence, 2 had both local and regional recurrence, and 6 had distant metastases. Five-year locoregional, disease-free, and overall survival rates were 45%, 40%, and 54%, respectively. Older age, poor tumor differentiation, positive surgical margin, and lymphovascular space invasion were found to be important prognostic factors for disease-related outcomes. Conclusions Prognosis of vulvar cancer remains poor even with a multidisciplinary approach. Molecular prognostic factors need to be defined for individualized treatment options to achieve better treatment results.
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International Multicenter Study on the Impact of Extracapsular Lymph Node Involvement in Primary Surgery Adenocarcinoma of the Esophagus on Overall Survival and Staging Systems. Ann Surg 2016; 262:809-15; discussion 815-6. [PMID: 26583670 DOI: 10.1097/sla.0000000000001463] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The current pathological lymph node (pN) staging is based on the number of positive lymph nodes but does not take into consideration characteristics of the involved lymph nodes itself. The current study aims to examine the prognostic value of extracapsular lymph node involvement (EC-LNI) and intracapsular lymph node involvement (IC-LNI) for esophageal adenocarcinoma treated by primary surgery. METHODS From the databases of five European high volume centers, 1639 adenocarcinoma patients with primary R0-resection were withheld after excluding 90-day mortality. Oncologic variables, including number of resected lymph nodes, number of resected positive lymph nodes, and EC-LNI/IC-LNI were examined. The Union Internationale contre le Cancer (UICC) 7th edition prognostic staging was used as baseline staging system. Statistical analysis was performed by Cox proportional hazards modeling and verified using the Random Survival Forest technique. RESULTS EC-LNI showed significantly worse overall 5-year survival compared with IC-LNI overall (13.4% vs 37.2%, P < 0.0001), including in each pN-category [16.4% vs 45.6% in pN1 (P < 0.0001), 16.1% vs 23.8% (P = 0.047) in pN2 (P = 0.065), and 8.7% vs 26.3% in pN3 categories, respectively]. pN1 IC-LNI patients show a 5-year overall survival comparable (P = 0.92) with stage IIB (ie, pT3N0). Reclassifying the UICC prognostic stages according to these findings into an adapted staging model showed a significant (P < 0.0001) increase in homogeneity, discriminatory ability, and monotonicity compared with the original UICC TNM 7th edition prognostic staging. CONCLUSIONS These data suggest that lymph node capsular status is an important prognostic factor and should be considered for the future edition of the TNM staging system for esophageal cancer.
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Sznurkowski JJ. Vulvar cancer: initial management and systematic review of literature on currently applied treatment approaches. Eur J Cancer Care (Engl) 2016; 25:638-46. [DOI: 10.1111/ecc.12455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 11/30/2022]
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Paño B, Sebastià C, Ripoll E, Paredes P, Salvador R, Buñesch L, Nicolau C. Pathways of lymphatic spread in gynecologic malignancies. Radiographics 2016; 35:916-45. [PMID: 25969940 DOI: 10.1148/rg.2015140086] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Precise radiologic evaluation of regional adenopathic involvement in pelvic gynecologic tumors is fundamental to clinical practice because of its prognostic and therapeutic significance. Likewise, the identification of metastatic adenopathies at posttreatment imaging is essential for assessing response and detecting recurrence. Similar to urologic neoplasms, gynecologic neoplasms most often spread regionally to the pelvic and retroperitoneal lymph nodes, following the normal drainage pathways of the pelvic organs. Familiarity with routes of dissemination, treatment options, and means of analyzing lymph node characteristics is crucial to determine the extent of disease. Two staging systems can be used in characterizing gynecologic malignancies: the FIGO (International Federation of Gynecology and Obstetrics) system, which is the most commonly and universally used, and the TNM (tumor, node, metastasis) system, which is based on clinical and/or pathologic classification. Anatomic assessment with multidetector computed tomography (CT) and magnetic resonance (MR) imaging is still the most commonly used technique for the detection of lymph node spread, which is mainly based on morphologic criteria, the most important of which is nodal size. However, size has limited diagnostic specificity. Consequently, functional imaging techniques such as diffusion-weighted MR imaging, positron emission tomography combined with CT, lymphoscintigraphy, and sentinel lymph node mapping, which are based on molecular and physiologic activity and allow more precise evaluation, are often incorporated into diagnostic imaging protocols for staging of gynecologic malignancies.
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Affiliation(s)
- Blanca Paño
- From the CDIC, Departments of Radiology (B.P., C.S., E.R., R.S., L.B., C.N.) and Nuclear Medicine (P.P.), Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
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The number of removed lymph nodes by inguinofemoral lymphadenectomy: impact on recurrence rates in patients with vulva carcinoma. Arch Gynecol Obstet 2015; 294:131-6. [DOI: 10.1007/s00404-015-3932-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/21/2015] [Indexed: 11/26/2022]
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Liu CE, Lu Y, Yao DS. Feasibility and Safety of Video Endoscopic Inguinal Lymphadenectomy in Vulvar Cancer: A Systematic Review. PLoS One 2015; 10:e0140873. [PMID: 26496391 PMCID: PMC4619862 DOI: 10.1371/journal.pone.0140873] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To systematically review previous studies and to evaluate the feasibility and safety of video endoscopic inguinal lymphadenectomy (VEIL) in vulvar cancer. METHODS We conducted a comprehensive review of studies published through September 2014 to retrieve all relevant articles. The PubMed, EMBASE, Web of Science, Cochrane Library, Wan Fang Data and Chinese National Knowledge Infrastructure databases were systematically searched for all relevant studies published in English or Chinese through September 2014. Data were abstracted independently by two reviewers, and any differences were resolved by consensus. RESULTS A total of 9 studies containing 249 VEIL procedures involving 138 patients were reviewed. Of the 249 VEIL procedures, only 1 (0.4%) was converted to an open procedure for suturing because of injury to the femoral vein. The range of operative time was 62 to 110 minutes, and the range of estimated blood loss was 5.5 to 22 ml. The range of the number of harvested lymph nodes was 7.3 to 16. The length of hospital stay varied from 7 to 13.6 days across reports. The incidence of lymph node metastasis was 19.7% (27/138), and the recurrence rate was 4.3% (3/70) within 3 to 41 months of follow-up. One or more short-term complications were documented in 18 of 138 (13.0%) patients. Complications after VEIL were observed in 14 (10.13%) patients and in 15 (6.0%) of the VEIL cases, including major lymphocyst formation in 9 (3.6%), lymphorrhea in 2 (0.8%), inguinal wound infection without wound breakdown in 3 (1.2%) and lymphedema in 1 (0.4%). CONCLUSIONS VEIL appears to be a feasible procedure in the management of vulvar cancer. There may be potential benefits that result in lower morbidity compared to traditional methods, but this has yet to be objectively proven.
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Affiliation(s)
- Chai-e Liu
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People’s Republic of China
| | - Yan Lu
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People’s Republic of China
| | - De-Sheng Yao
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People’s Republic of China
- * E-mail:
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Luchini C, Nottegar A, Solmi M, Sergi G, Manzato E, Capelli P, Scarpa A, Veronese N. Prognostic implications of extranodal extension in node-positive squamous cell carcinoma of the vulva: A systematic review and meta-analysis. Surg Oncol 2015; 25:60-5. [PMID: 26394825 DOI: 10.1016/j.suronc.2015.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 12/23/2022]
Abstract
Squamous cell carcinoma (SCC) of the vulva is the fourth most common gynecological cancer, usually staged with the TNM or FIGO systems. Since 2009, FIGO staging has taken the extranodal extension (ENE) of lymph node metastases into account. ENE is defined as the spread of a lymph node metastasis into surrounding soft tissue. Although the TNM and FIGO systems acknowledge the importance of ENE in SCC, no comprehensive studies have analyzed the prognostic impact of this parameter. We therefore queried the PubMed and SCOPUS databases from their inception up until 04/01/2015, adopting no language restrictions: all prospective studies reporting on prognostic parameters in patients with vulvar SCC, and comparing participants with and without ENE were eligible for our analysis. Data were summarized using risk ratios (RR) for the number of deaths/recurrences and hazard ratios (HR) for the time-dependent risk related to ENE positivity, adjusting for potential confounders. Among 859 hits, 13 studies were found eligible and were included in our meta-analysis. Compared with ENE-negative (ENE-) cases, the ENE-positive (ENE+) patients had significantly higher rates of all-cause mortality (6 studies: RR = 3.18; 95%CI: 2.02-5.00, p < 0.0001, I(2) = 56%), cancer-specific mortality (3 studies: RR = 2.03; 95%CI: 1.12-3.69, p = 0.02, I(2) = 80%), and recurrence (4 studies: RR = 2.69, 95%CI: 1.61-3.76, p < 0.0001, I(2) = 57%). Using HRs after adjusting for potential confounders, ENE + carried a significantly higher risk of all-cause mortality (6 studies: HR = 3.08, 95%CI: 1.73-5.48, p < 0.0001, I(2) = 66%), and recurrence (5 studies: HR = 3.93, 95%CI: 2.33-6.62, p < 0.0001, I(2) = 28%). Our meta-analysis clarifies the prognostic significance of ENE in vulvar SCC, also pointing to its implications for gross sampling, histology and oncological staging.
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Affiliation(s)
- Claudio Luchini
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Piazzale Scuro, 10, 37134 Verona, Italy.
| | - Alessia Nottegar
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Piazzale Scuro, 10, 37134 Verona, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padua, Via Giustiniani, 5, 35128 Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine, DIMED, University of Padua, Via Giustiani, 2, 35128 Padova, Italy
| | - Enzo Manzato
- Department of Medicine, DIMED, University of Padua, Via Giustiani, 2, 35128 Padova, Italy
| | - Paola Capelli
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Piazzale Scuro, 10, 37134 Verona, Italy
| | - Aldo Scarpa
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Piazzale Scuro, 10, 37134 Verona, Italy
| | - Nicola Veronese
- Department of Medicine, DIMED, University of Padua, Via Giustiani, 2, 35128 Padova, Italy
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Hacker NF, Barlow EL. Staging for vulvar cancer. Best Pract Res Clin Obstet Gynaecol 2015; 29:802-11. [DOI: 10.1016/j.bpobgyn.2015.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/27/2015] [Indexed: 11/16/2022]
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Panici PB, Tomao F, Domenici L, Giannini A, Giannarelli D, Palaia I, Di Donato V, Musella A, Angioli R, Muzii L. Prognostic role of inguinal lymphadenectomy in vulvar squamous carcinoma: younger and older patients should be equally treated. A prospective study and literature review. Gynecol Oncol 2015; 137:373-9. [DOI: 10.1016/j.ygyno.2015.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/09/2015] [Indexed: 11/25/2022]
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Li J, Cai Y, Ke G, Xiang L, Wang L, Yang W, Wu X, Yang H. Validation of the new FIGO staging system (2009) for vulvar cancer in the Chinese population. Gynecol Oncol 2015; 137:274-9. [DOI: 10.1016/j.ygyno.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/01/2015] [Indexed: 11/15/2022]
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Study of biomolecular and clinical prognostic factors in patients with cancer of the vulva undergoing surgical treatment. Int J Gynecol Cancer 2015; 24:766-72. [PMID: 24552893 DOI: 10.1097/igc.0000000000000103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cancers of the vulva account for 3% to 5% of all cancers of the female genital. This study was conducted to evaluate clinical, pathological, and molecular prognostic factors in patients with cancer of the vulva. METHODS Patients with squamous cell carcinoma of the vulva who had undergone surgical treatment at the Department of Pelvic Surgery and Gynecology Service, Aristides Maltez Hospital, between June 1993 and June 2011 were selected. Clinical, epidemiological, pathological, and molecular characteristics related to the prognosis of these patients were evaluated in relation to the prognosis. In the molecular evaluation, we studied the expression of p53 and matrix metalloproteinase 2 by immunohistochemistry. RESULTS Seventy-five patients were eligible for the study. In multivariable analysis, factors related to survival were as follows: tumor size larger than 4 cm (P = 0.014), an invasion depth greater than 2 mm (P = 0.023) and matrix metalloproteinase 2 expression in more than 50% of the tumor cells (P = 0.046). With the use of the relative risks of the factors identified in the multivariable analysis, a point count was developed for a prognostic classification (the score classifies patients into 3 categories). CONCLUSIONS A tumor size larger than 4 cm, an invasion depth greater than 2 mm, and metalloproteinase 2 expression in more than 50% of the tumor cells seem to be related to lower overall survival rate in patients with cancer of the vulva undergoing surgical treatment. A classification of the patient's prognosis can be performed using a point count based on these relative risks.
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Matsuo K, Yoshino K, Hasegawa K, Murakami R, Ikeda Y, Adachi S, Hiramatsu K, Yokoyama T, Nishimura M, Sheridan TB, Enomoto T, Fujiwara K, Matsumura N, Konishi I, Fotopoulou C, Roman LD, Sood AK. Survival outcome of stage I ovarian clear cell carcinoma with lympho-vascular space invasion. Gynecol Oncol 2015; 136:198-204. [DOI: 10.1016/j.ygyno.2014.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/27/2014] [Accepted: 12/03/2014] [Indexed: 01/22/2023]
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Hinten F, van den Einden LCG, Cissen M, IntHout J, Massuger LFAG, de Hullu JA. Clitoral involvement of squamous cell carcinoma of the vulva: localization with the worst prognosis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:592-8. [PMID: 25638604 DOI: 10.1016/j.ejso.2015.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The overall 5-year survival of patients with vulvar squamous cell carcinoma (SCC) is 70%. The clinical impression is that localization of SCC on the clitoris may lead to worse prognosis. The aim of this study is to assess the disease specific survival (DSS) in patients with clitoral SCC compared to patients with SCC without clitoral involvement. METHODS All consecutive patients with primary vulvar SCC treated with surgery at the Department of Gynaecologic Oncology at the Radboud university medical centre (Radboudumc) between March 1988 and January 2012, were analysed. The clinical and histopathological characteristics and DSS rates of patients with (N = 72) and without clitoral SCC (N = 275) were compared. Furthermore, patients with clitoral involvement were compared to patients with perineal SCCs (N = 52) and other central SCCs without clitoral and/or perineal involvement (N = 117). RESULTS Patients with clitoral SCC more often had larger and deeper invaded tumours, lymphovascular space involvement (LVSI), positive surgical margins and a higher percentage of positive lymph nodes. Kaplan-Meier survival analyses showed worse DSS in patients with a clitoral SCC compared to patients without clitoral involvement. Multivariable analysis showed that not clitoral involvement, but invasion depth, differentiation grade and lymph node status are independent prognostic factors. CONCLUSIONS Patients with clitoral SCC have worse survival compared to patients without clitoral involvement. This is probably caused by unfavourable histopathological characteristics of the tumour rather than the localization itself. Prospective studies are needed to further assess the influence of localization of the vulvar SCC on prognosis.
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Affiliation(s)
- F Hinten
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - L C G van den Einden
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - M Cissen
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - J IntHout
- Radboud University Medical Centre, Department for Health Evidence, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - L F A G Massuger
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - J A de Hullu
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Matsuo K, Sheridan TB, Mabuchi S, Yoshino K, Hasegawa K, Studeman KD, Im DD, Rosenshein NB, Roman LD, Sood AK. Estrogen receptor expression and increased risk of lymphovascular space invasion in high-grade serous ovarian carcinoma. Gynecol Oncol 2014; 133:473-9. [PMID: 24674832 DOI: 10.1016/j.ygyno.2014.03.563] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Recent studies have demonstrated that lymphovascular space invasion (LVSI) is associated with increased risk of hematogenous and lymphatic metastasis and poor clinical outcome of women with epithelial ovarian cancer. Given the suspected role of estrogen in promoting ovarian cancer metastasis, we examined potential links between estrogen receptor and LVSI in high-grade serous ovarian carcinoma. METHODS Tumoral expression of ER, PR, p53, MDR1, EGFR, HER2, DNA ploidy, and S-phase fraction was examined for 121 cases of stage I-IV high-grade serous ovarian carcinoma samples obtained at primary cytoreductive surgery. Biomarker expression was correlated to LVSI and survival outcomes. RESULTS LVSI was observed in 101 (83.5%) of all cases. Immunohistochemistry of tested biomarkers showed ER (86.7%) to be the most commonly expressed followed by p53 (71.4%), HER2 (68.3%), EGFR (52.1%), MDR-1 (14.3%), and PR (8.9%). ER expression was positively correlated to PR expression (r=0.31, p=0.001). LVSI was only correlated with ER (odds ratio 6.27, 95%CI 1.93-20.4, p=0.002) but not with other biomarkers. In multivariate analysis, ER remained significantly associated with LVSI (p=0.039). LVSI remained a significant prognostic factor for decreased progression-free survival (HR 3.01, 95%CI 1.54-5.88, p=0.001) and overall survival (HR 2.69, 95%CI 1.18-6.23, p=0.021) while ER-expression did not remain as a significant variable in multivariate analysis. CONCLUSION Our data demonstrated that estrogen receptor was positively correlated with LVSI that was an independent prognostic indicator of poor survival outcomes of high-grade serous ovarian carcinoma. This study emphasizes the importance of estrogen pathway in promoting lymphatic or vascular spread of high-grade serous ovarian carcinoma.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
| | - Todd B Sheridan
- Department of Pathology, Mercy Medical Center, Baltimore, MD, USA
| | - Seiji Mabuchi
- Department of Obstetrics and Gynecology, Osaka University Faculty of Medicine, Suita, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Faculty of Medicine, Suita, Osaka, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | | | - Dwight D Im
- Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA
| | - Neil B Rosenshein
- Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Anil K Sood
- Department of Gynecologic Oncology, UT MD Anderson Cancer Center, Houston, TX, USA; Department of Cancer Biology, UT MD Anderson Cancer Center, Houston, TX, USA; Center for RNA Interference and non-Coding RNA, University of Texas, Houston, TX, USA
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Aragona AM, Cuneo NA, Soderini AH, Alcoba EB. An analysis of reported independent prognostic factors for survival in squamous cell carcinoma of the vulva: Is tumor size significance being underrated? Gynecol Oncol 2014; 132:643-8. [DOI: 10.1016/j.ygyno.2013.12.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/09/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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van de Nieuwenhof HP, Oonk MHM, de Hullu JA, van der Zee AGJ. Vulvar squamous cell carcinoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Raspagliesi F, Zanaboni F, Martinelli F, Scasso S, Laufer J, Ditto A. Role of paclitaxel and cisplatin as the neoadjuvant treatment for locally advanced squamous cell carcinoma of the vulva. J Gynecol Oncol 2014; 25:22-9. [PMID: 24459577 PMCID: PMC3893670 DOI: 10.3802/jgo.2014.25.1.22] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 11/30/2022] Open
Abstract
Objective The therapeutic outcomes of patients with advanced vulvar cancer are poor. Multi-modality treatments including concurrent chemoradiation or different regimens of neoadjuvant chemotherapy (NACT), and surgery have been explored to reduce the extent of surgery and morbidity. The present single-institution trial aimed to evaluate the efficacy and toxicity of paclitaxel and cisplatin in locally advanced vulvar cancer. Methods From 2002 to 2009, 10 patients with stage III-IV locally advanced squamous cell carcinoma of the vulva were prospectively treated with 3 courses of paclitaxel-ifosfamide-cisplatin or paclitaxel-cisplatin. Nine of them subsequently underwent radical local excision or radical partial vulvectomy and bilateral inguino-femoral lymphadenectomy. Results The clinical response rate of all enrolled patients was 80%, whereas the pathological responses included 1 case with complete remission, 2 with persistent carcinoma in situ, and 6 invasive cancer cases with tumor shrinkage of more than 50%. Four patients had positive nodes. Forty percent of patients experienced grade 3-4 bone marrow toxicity, which was successfully managed with granulocyte-colony stimulating factor, even in cases of elderly patients. Median progression-free survival after surgery was 14 months (range, 5 to 44 months). Six of the 7 recurrent cases were local, and 3 of them were treated with salvage surgery while the other 3 received radiation with or without chemotherapy. After a median follow-up period of 40 months (range, 5 to 112 months), 55.5% of patients remained alive with no evidence of disease, including 2 long-term survivors after recurrence at 5 and 9 years. Conclusion Based on the high response rate and manageable toxicity, NACT with paclitaxel and cisplatin with or without ifosfamide followed by surgery could be considered as a therapeutic option for locally advanced vulvar cancer.
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Affiliation(s)
- Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Flavia Zanaboni
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Santiago Scasso
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. ; Department of Obstetrics and Gynecology, University of Uruguay School of Medicine, Montevideo, Uruguay
| | - Joel Laufer
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. ; Department of Obstetrics and Gynecology, University of Uruguay School of Medicine, Montevideo, Uruguay
| | - Antonino Ditto
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Baiocchi G, Silva Cestari F, Rocha R, Lavorato-Rocha A, Maia B, Cestari L, Kumagai L, Faloppa C, Fukazawa E, Badiglian-Filho L, Sant'Ana Rodrigues I, Soares F. Prognostic value of the number and laterality of metastatic inguinal lymph nodes in vulvar cancer: Revisiting the FIGO staging system. Eur J Surg Oncol 2013; 39:780-5. [DOI: 10.1016/j.ejso.2013.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 01/25/2013] [Accepted: 03/04/2013] [Indexed: 11/28/2022] Open
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Baiocchi G, Silva Cestari F, Rocha R, Faloppa C, Kumagai L, Fukazawa E, Badiglian-Filho L, Cestari L, Sant’Ana Rodrigues I, Lavorato-Rocha A, Maia B, Soares F. Does the count after inguinofemoral lymphadenectomy in vulvar cancer correlate with outcome? Eur J Surg Oncol 2013; 39:339-43. [DOI: 10.1016/j.ejso.2013.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 01/09/2013] [Accepted: 02/01/2013] [Indexed: 11/28/2022] Open
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Impact of the new FIGO 2009 staging classification for vulvar cancer on prognosis and stage distribution. Gynecol Oncol 2012; 127:147-52. [DOI: 10.1016/j.ygyno.2012.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 05/31/2012] [Accepted: 06/04/2012] [Indexed: 11/21/2022]
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Matsuo K, Sheridan TB, Yoshino K, Miyake T, Hew KE, Im DD, Rosenshein NB, Mabuchi S, Enomoto T, Kimura T, Sood AK, Roman LD. Significance of lymphovascular space invasion in epithelial ovarian cancer. Cancer Med 2012; 1:156-64. [PMID: 23342265 PMCID: PMC3544453 DOI: 10.1002/cam4.31] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 12/18/2022] Open
Abstract
While the prognostic significance of lymphovascular space invasion (LVSI) is well established in endometrial and cervical cancer, its role in ovarian cancer is not fully understood. First, a training cohort was conducted to explore whether the presence and quantity of LVSI within the ovarian tumor correlated with nodal metastasis and survival (n = 127). Next, the results of the training cohort were applied to a different study population (validation cohort, n = 93). In both cohorts, histopathology slides of epithelial ovarian cancer cases that underwent primary cytoreductive surgery including pelvic and/or aortic lymphadenectomy were examined. In a post hoc analysis, the significance of LVSI was evaluated in apparent stage I cases (n = 53). In the training cohort, the majority of patients had advanced-stage disease (82.7%). LVSI was observed in 79.5% of cases, and nodal metastasis was the strongest variable associated with the presence of LVSI (odds ratio [OR]: 7.99, 95% confidence interval [CI]: 1.98–32.1, P = 0.003) in multivariate analysis. The presence of LVSI correlated with a worsened progression-free survival on multivariate analysis (hazard ratio [HR]: 2.06, 95% CI: 1.01–4.24, P = 0.048). The significance of the presence of LVSI was reproduced in the validation cohort (majority, early stage 61.3%). In apparent stage I cases, the presence of LVSI was associated with a high negative predictive value for nodal metastasis (100%, likelihood ratio, P = 0.034) and with worsened progression-free survival (HR: 5.16, 95% CI: 1.00–26.6, P = 0.028). The presence of LVSI is an independent predictive indicator of nodal metastasis and is associated with worse clinical outcome of patients with epithelial ovarian cancer.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California Los Angeles, CA, USA.
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Abstract
BACKGROUND The previous (1988) International Federation of Gynecology and Obstetrics (FIGO) vulval cancer staging system failed in 3 important areas: (1) stage 1 and 2 disease showed similar survival; (2) stage 3 represented a most heterogeneous group of patients with a wide survival range; and (3) the number and morphology of positive nodes were not taken into account. OBJECTIVE To compare the 1988 FIGO vulval carcinoma staging system with that of 2009 with regard to stage migration and prognostication. METHODS Information on all patients treated for vulval cancer at the Queensland Centre for Gynecological Cancers, Australia, between 1988 to the present was obtained. Data included patients' characteristics as well as details on histopathology, treatments, and follow-up. We recorded the original 1988 FIGO stage, reviewed all patients' histopathology information, and restaged all patients to the 2009 FIGO staging system. Data were analyzed using the Kaplan-Meier method to compare relapse-free survival and overall survival. RESULTS Data from 394 patients with primary vulval carcinoma were eligible for analysis. Patients with stage IA disease remained unchanged. Tumors formerly classified as stage II are now classified as stage IB. Therefore, FIGO 2009 stage II has become rare, with only 6 of 394 patients allocated to stage II. Stage III has been broken down into 3 substages, thus creating distinct differences in relapse-free survival and overall survival. Prognosis of patients with stage IIIC disease is remarkably poor. CONCLUSION The FIGO 2009 staging system for vulval carcinoma successfully addresses some concerns of the 1988 system. Especially, it identifies high-risk patients within the heterogeneous group of lymph node-positive patients.
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Kowalewska M, Radziszewski J, Goryca K, Bujko M, Oczko-Wojciechowska M, Jarzab M, Siedlecki JA, Bidzinski M. Estimation of groin recurrence risk in patients with squamous cell vulvar carcinoma by the assessment of marker gene expression in the lymph nodes. BMC Cancer 2012; 12:223. [PMID: 22673103 PMCID: PMC3414830 DOI: 10.1186/1471-2407-12-223] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 06/06/2012] [Indexed: 01/11/2023] Open
Abstract
Background Regional lymph node (LN) status is a well-known prognostic factor for vulvar carcinoma (VC) patients. Although the reliable LN assessment in VC is crucial, it presents significant diagnostic problems. We aimed to identify specific mRNA markers of VC dissemination in the LN and to address the feasibility of predicting the risk of nodal recurrence by the patterns of gene expression. Methods Sentinel and inguinal LN samples from 20 patients who had undergone surgery for stage T1-3, N0-2, M0 primary vulvar squamous cell carcinoma were analyzed. Gene expression profiles were assessed in four metastatic [LN(+)] and four histologically negative [LN(−)] lymph node samples obtained from four VC patients, by the Affymetrix U133 Plus 2.0 gene expression microarrays. Of the set of genes of the highest expression in the metastatic LNs compared to LN(−), seven candidate marker genes were selected: PERP, S100A8, FABP5, SFN, CA12, JUP and CSTA, and the expression levels of these genes were further analyzed by the real-time reverse transcription polymerase chain reaction (qRT-PCR) in 71 LN samples. Results All of the seven genes in question were significantly increased in LN(+) compared to LN(−) samples. In the initial validation of the seven putative markers of metastatic LN, the Cox proportional hazard model pointed to SFN, CA12 and JUP expression to significantly relate to the time to groin recurrence in VC patients. Conclusions Our findings first provided evidence that SFN, CA12 and JUP have a potential of marker genes for the prediction of the groin recurrence LN in VC patients.
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Affiliation(s)
- Magdalena Kowalewska
- Department of Molecular Biology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
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