Clinical and Pathological Prognostic Factors in Squamous Cell Carcinoma of the Vulva

Abstract

ABSTRACT Approximately 4% of gynecologic cancers are invasive carcinomas of the vulva. This retrospective study was intended to determine the prognostic importance of clinical variables in 389 women seen in the years 1978 through 1995 with squamous cell carcinoma of the vulva. In addition, the prognostic value of tumor characteristics and lymph node metastases was examined in a subgroup of 110 patients with node involvement. They represented approximately one third of patients who underwent lymph node dissection. Surgery consisted of radical vulvectomy modified radical vulvectomy or wide excision of the primary tumor, depending on the extensiveness of the tumor. Follow up averaged nearly 13 years. Overall, 5-year and 10-year survival rates were 66% and 62%, respectively. Univariate analysis identified age, the clinical features of the tumor, lymphovascular space involvement (LVSI), and lymph node status as significant predictors of survival. All patients presenting before age 30 lived 10 years compared with 53% of those older than 60. Patients with ulcerated tumors had a poorer outlook than those with exophytic tumors. A lack of LVSI doubled the chance of living 10 years or longer (61% vs 30%). The most important factor was nodal status; actuarial 10-year survival rates were 76% and 39.5%, respectively, for node-negative and node-positive patients. Neither tumor diameter nor extension of lymphadenectomy to the pelvic chains influenced survival. On multivariate analysis, the most significant independent prognostic factors were the percentage of nodal replacement (hazard ratio [HR], 6.99; 95% confidence interval [CI], 3.51–16.14) and extracapsular spread (HR, 4.88; 95% CI, 2.96–10.14). The investigators conclude that in women with invasive squamous cell carcinoma of the vulva, lymph node status and such nodal features as extracapsular spread and the rate of node replacement can help to identify high-risk patients who may benefit from adjuvant treatment.