Margins in vulvar cancer: challenges to classical clinicopathologic vulvar recurrence risk factors

Abstract

Vulvar cancer is a disease for which treatment may carry significant morbidity, but treatment failure causes significant mortality. Despite radical surgery, the risk of local recurrence is significant [ [1] Te Grootenhuis N.C. Pouwer A.W. de Bock G.H. Hollema H. Bulten J. van der Zee A.G.J. et al. Prognostic factors for local recurrence of squamous cell carcinoma of the vulva: A systematic review. Gynecol. Oncol. 2018 /03/01; 148: 622-631 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar ]. Consideration of vulvar recurrence risk factors is imperative, as long-term follow-up from the GROINSS-V-I study demonstrated a significant detriment to disease-specific survival at 10 years in the case of vulvar local recurrence (90.4% vs. 68.7%), whereas previously only nodal control was thought to impact survival [ [2] Te Grootenhuis N.C. van der Zee A.G. van Doorn H.C. van der Velden J. Vergote I. Zanagnolo V. et al. Sentinel nodes in vulvar cancer: Long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I. Gynecol. Oncol. 2016 /01/01; 140: 8-14 Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar , [3] Oonk M.H. van Hemel B.M. Hollema H. de Hullu J.A. Ansink A.C. Vergote I. et al. 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 study. Lancet Oncol. 2010 /07/01; 11: 646-652 Abstract Full Text Full Text PDF PubMed Scopus (196) Google Scholar ]. Historically, pathologic close margins have been defined as <8mm, which has led to the classic recommendation of surgical margins greater than 1cm [ [4] Heaps J.M. Fu Y.S. Montz F.J. Hacker N.F. Berek J.S. Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol. Oncol. 1990 /09/01; 38: 309-314 Abstract Full Text PDF PubMed Scopus (355) Google Scholar ] . This recommendation has been challenged as retrospective data have emerged supporting the use of smaller resection margins due to an unclear relationship between close tumor resection margins and the risk of local recurrence [ [5] Arvas M. Kahramanoglu I. Bese T. Turan H. Sozen I. Ilvan S. et al. The Role of Pathological Margin Distance and Prognostic Factors After Primary Surgery in Squamous Cell Carcinoma of the Vulva. Int. J. Gynecol. Cancer. 2018 Mar; 28: 623-631 Crossref PubMed Scopus (15) Google Scholar , [6] Baiocchi G. Mantoan H. de Brot L. Badiglian-Filho L. Kumagai L.Y. Faloppa C.C. da Costa A.A. How important is the pathological margin distance in vulvar cancer?. Eur. J. Surg. Oncol. 2015 /12/01; 41: 1653-1658 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar ].