Adjuvant treatment for vulvar cancer with macro-metastatic inguinofemoral lymph nodes

Abstract

Objectives: To describe uptake of sentinel lymph node (SLN) procedures in apparent early stage vulvar squamous cell carcinoma (SCC) and determine the association between adjuvant therapy and overall survival (OS) among patients with macro-metastatic inguinofemoral lymph nodes (IFLN). Methods: National Cancer Database (NCDB) patients undergoing vulvar resection and nodal assessment for unifocal, stage IB vulvar SCC measuring < 4 cm from 2012-2016 were included. Patients with bulky IFLN were excluded. OS was assessed using Kaplan-Meier estimation. Multivariable Cox proportional hazards regression was used to identify factors associated with OS. Results: A total of 558 women met inclusion criteria, of which 166 underwent any SLN procedure and 87 underwent SLN assessment alone (SLND). Proportion of women undergoing SLN procedures significantly increased over time (10.5% in 2012 to 19.1% in 2016, p<0.001). Among patients with macro-metastatic IFLN diagnosed after SLND (n=46), adjuvant radiation was associated with improved OS (adjusted hazards ratio [aHR]=0.07, p=0.003), and there was a trend toward improved OS with increasing radiation dose (aHR 0.85 for each 500 cGy increase, p=0.157) and radiosensitizing chemotherapy (aHR 0.20, p=0.127) among irradiated patients (n=33). Adjuvant therapy was not detected to be associated with OS in women undergoing full lymph node dissection (LND). Among patients with macro-metastatic IFLN, there was a trend towards improved OS after SLND plus chemoradiation compared to full LND plus radiation alone (aHR=0.43, p=0.162). Conclusions: Uptake of SLN procedures increased over time. Among patients with macro-metastatic IFLN undergoing SLND, adjuvant radiation was associated with improved OS. SLND plus chemoradiation compared favorably to full LND plus radiation alone, though small sample sizes limited statistical significance. To describe uptake of sentinel lymph node (SLN) procedures in apparent early stage vulvar squamous cell carcinoma (SCC) and determine the association between adjuvant therapy and overall survival (OS) among patients with macro-metastatic inguinofemoral lymph nodes (IFLN). National Cancer Database (NCDB) patients undergoing vulvar resection and nodal assessment for unifocal, stage IB vulvar SCC measuring < 4 cm from 2012-2016 were included. Patients with bulky IFLN were excluded. OS was assessed using Kaplan-Meier estimation. Multivariable Cox proportional hazards regression was used to identify factors associated with OS. A total of 558 women met inclusion criteria, of which 166 underwent any SLN procedure and 87 underwent SLN assessment alone (SLND). Proportion of women undergoing SLN procedures significantly increased over time (10.5% in 2012 to 19.1% in 2016, p<0.001). Among patients with macro-metastatic IFLN diagnosed after SLND (n=46), adjuvant radiation was associated with improved OS (adjusted hazards ratio [aHR]=0.07, p=0.003), and there was a trend toward improved OS with increasing radiation dose (aHR 0.85 for each 500 cGy increase, p=0.157) and radiosensitizing chemotherapy (aHR 0.20, p=0.127) among irradiated patients (n=33). Adjuvant therapy was not detected to be associated with OS in women undergoing full lymph node dissection (LND). Among patients with macro-metastatic IFLN, there was a trend towards improved OS after SLND plus chemoradiation compared to full LND plus radiation alone (aHR=0.43, p=0.162). Uptake of SLN procedures increased over time. Among patients with macro-metastatic IFLN undergoing SLND, adjuvant radiation was associated with improved OS. SLND plus chemoradiation compared favorably to full LND plus radiation alone, though small sample sizes limited statistical significance.