Abstract
BackgroundThe value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general.Patients and MethodsN = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018. In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement.ResultsThe majority had T1b/T2 tumors (n = 15, 78.9%) with a median diameter of 40 mm (11–110 mm). 17/21 patients showed positive inguinal nodes. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients with positive groin nodes also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1–8)). These 6 patients were highly node positive with median 4.5 (2–9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed. Five recurrences were observed after a median follow-up of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group. Patients with pelvic metastasis at first diagnosis had a median progression-free survival of only 9.9 months and overall-survival of 31.1 months.ConclusionA relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.
Highlights
Within the last two decades, the incidence of vulvar squamous cell cancer (VSCC) constantly increased and eventually doubled to currently 3–5/100,000/year in Europe [1]—VSCC remains a rare disease comprising approximately 5–6% of all gynecological malignancies [2]
The number of groin nodes affected seems to correlate with the risk of experiencing pelvic metastases—in this context, an increasing number of metastatic groin nodes is associated with an elevated risk for pelvic nodal involvement [12, 13]
The aim of this study was to investigate the relation between inguinal und pelvic lymph node involvement (Table 1). This retrospective subgroup analysis focuses on patients who were diagnosed with primary VSCC FIGO stage IB and higher and were treated with pelvic LAE (n = 21) at the University Medical Center Hamburg-Eppendorf between 1996 and 2018
Summary
Within the last two decades, the incidence of vulvar squamous cell cancer (VSCC) constantly increased and eventually doubled to currently 3–5/100,000/year in Europe [1]—VSCC remains a rare disease comprising approximately 5–6% of all gynecological malignancies [2]. The value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general. Patients and Methods N = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018 In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement. 6/17 node-positive patients with positive groin nodes had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1–8)). Conclusion A relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC
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