Prognostic Role of Lymph Node Metastases in Vulvar Cancer and Implications for Adjuvant Treatment
- 1 March 2012
- journal article
- research article
- Published by BMJ in International Journal of Gynecologic Cancer
- Vol. 22 (3), 503-508
- https://doi.org/10.1097/igc.0b013e31823eed4c
Abstract
Objective: Lymph node metastases are the most important prognostic factor for recurrence and survival in vulvar cancer. However, information regarding the impact of the number of positive nodes in vulvar cancer is inconsistent, and so are recommendations when to apply adjuvant radiotherapy.Methods: One hundred fifty-seven consecutive patients with primary squamous cell cancer of the vulva treated at our center were analyzed. All patients underwent primary surgery by triple incision resulting in complete tumor resection.Results: Median age was 61 years; 49 patients (31%) had lymph node metastases; 21 patients had 1, 13 had 2, and 15 had more than 2 positive lymph nodes. Thirty-two percent of the patients received adjuvant radiotherapy. The risk of lymph node metastases increased with age, greater tumor size, deeper invasion, and higher tumor grade. Median follow-up was 36 months; 23 patients (14.6%) developed disease recurrence (61% vulva, 35% groins, and 4% both). Compared with node-negative patients, survival in all node-positive patients was significantly impaired (P < 0.001; disease-free patients after 2 years: 88% in node-negative patients; 60%, 43%, and 29% in patients with 1, 2, and >2 affected nodes, respectively), whereas no significant difference between the node-positive subgroups could be demonstrated regarding disease-free survival. In multivariate analysis, lymph node status remained the most important prognostic factor regarding disease-free survival, but the effect of positive nodes differed significantly dependent on adjuvant treatment (P = 0.001). In patients without adjuvant radiotherapy to the groins/pelvis, the number of metastatic nodes was highly relevant for prognosis (hazard ratio, 1.752; P < 0.001), whereas this effect disappeared in patients who were treated with adjuvant radiotherapy (hazard ratio, 0.972; P = 0.828).Conclusions: The negative impact of lymph node metastases is already evident in patients with only 1 affected lymph node. In patients receiving adjuvant radiotherapy, the negative effect of additional lymph node metastases is reduced; adjuvant treatment might therefore be beneficial in patients with only 1 positive node.Keywords
This publication has 11 references indexed in Scilit:
- Current controversies in the management of patients with early-stage vulvar cancerCurrent Opinion in Oncology, 2010
- Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational studyThe Lancet Oncology, 2010
- Adjuvant radiotherapy in patients with vulvar cancer and one intra capsular lymph node metastasis is not beneficialGynecologic Oncology, 2009
- Cancer Statistics, 2007CA: A Cancer Journal for Clinicians, 2007
- Old and new perspectives in the management of high-risk, locally advanced or recurrent, and metastatic vulvar cancerCritical Reviews in Oncology/Hematology, 2006
- Trends in the Incidence of Invasive and In Situ Vulvar CarcinomaObstetrics & Gynecology, 2006
- Patterns of recurrence and disease-free survival in advanced squamous cell carcinoma of the vulvaGynecologic Oncology, 2004
- Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survivalCancer, 1995
- Prognostic significance of lymph node variables in squamous cell carcinoma of the vulvaCancer, 1994
- Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva Stage III and IVA FIGOGynecologic Oncology, 1992