The effect of lymph node metastasis on overall survival and disease-free survival in vulvar cancer patients

Lymph Node Metastasis and Patterns of Recurrence in Vulvar Carcinoma: 10 Years' Single Center Experience

Vulvar carcinoma is a relatively rare malignancy and there is a paucity of data, especially from India and other developing countries regarding the prognostic factors impacting recurrence and survival. A retrospective observational study was conducted in the Department of Gynecologic Oncology at a tertiary care, regional cancer institute, including all patients with carcinoma vulva who underwent surgery between 2009 and 2018. Demographic profile, surgical-pathological information, details of neo-adjuvant chemotherapy, adjuvant radiation and chemotherapy, and peri-operative complications were analyzed. Long-term follow-up data was gathered, with an evaluation of various prognostic factors impacting recurrence and overall survival outcome. Forty-five cases with mean age of 56.2 years (range 29-82) were treated during the study period. Surgery was the initial treatment modality in 41 (91.1%) cases. Neo-adjuvant chemotherapy prior to surgery was given to four cases. After complete surgico-pathological staging, most patients had stage I disease (26 cases, 57.8%) and 22.2% had stage II disease. Owing to microscopic lymph node involvement, seven cases (15.6%) belonged to FIGO stage III disease. Two cases had stage IVA disease with fixed groin nodes. Adjuvant chemotherapy in the form of 5-fluoro uracil and cisplatin was administered to four out of the nine patients with nodal involvement. The remaining five were advised adjuvant groin radiation. At a median follow-up of 34 months (range 2-114 months), 12 cases (26.7%) experienced a recurrence and one case with stage IVA disease progressed during adjuvant chemotherapy. The 5-year overall survival was 76.6% and the 5-year disease-free survival was 69.6%. There were a total number of 10 deaths, of which seven were due to disease recurrence or progression and the remaining 30% of deaths were due to medical co-morbid conditions. Overall survival was negatively impacted by increasing age (age > 60 years), number of positive nodes, presence of perinodal spread, and stage of the disease. Recurrence-free survival was significantly reduced in those with the presence of peri-nodal spread and lympho-vascular space invasion. The incidence of lymph node metastasis was found to be higher in patients with age > 60 years, increasing tumor size, presence of lympho-vascular space invasion and the number of lymph nodes removed. In carcinoma vulva, treatment should be individualized with multidisciplinary cooperation. In our series, we found that the stage of disease, nodal positivity, and nodal positivity with extra-capsular spread were significant prognostic factors impacting survival on analysis. Lymph nodal positivity was associated with increasing tumour size, presence of lympho-vascular invasion, and patient age.

Prognostic factors in patients with recurrent squamous cell carcinoma of the vulva and the ınfluence of recurrence to the overall survival

Aim: The effects of many factors have been investigated in vulvar cancer patients with recurrence. In our study, we aimed to compare clinical and pathological factors and investigate the effect of recurrence on overall survival in patients with recurrent and non-recurrent squamous cell vulvar cancer. Materials and Methods: The files of vulvar cancer patients who were operated in İzmir Tepecik Education and Research Hospital Gynecological Oncology Clinic between 1995 and 2018 and were followed up in our hospital were retrospectively reviewed. Patients were divided into two groups, with and without recurrence. The groups were compared in terms of age, stage, tumor size, midline status of the tumor, localization of the tumor, operation, surgical margin, depth of tumor invasion, presence of metastatic lymph node, adjuvant therapy variables and the effect of recurrence on survival was investigated. Results: Variables such as age, stage, tumor size, midline status of the tumor, localization of the tumor, operation, surgical margin, tumor invasion depth, presence of metastatic lymph node, adjuvant therapy were not found to be statistically significant in terms of recurrent patients with vulvar cancer. There was also no correlation between recurrence and overall survival. Conclusion: Many prognostic factors mentioned in the literature were not found to be significant in terms of recurrence in our study, and no difference was found between the groups with and without recurrence in terms of overall survival.