Prognostic factors in node-negative vulvar cancer.

Abstract

e15514 Background: Lymph-node metastases to the groin are the most important prognostic factor in vulvar cancer. Prognosis in node-negative vulvar cancer is generally favorable, however, in a small proportion of node-negative patients disease recurs early with the need for radical salvage interventions. There are currently no prognostic factors available to identify this subset of patients. We therefore analyzed a large and homogeneously treated group of patients with node-negative vulvar cancer to identify possible prognostic factors for recurrence and survival. Methods: One-hundred-and-eight consecutive node-negative patients with primary squamous cell cancer of the vulva treated at our center between 1998 and 2008 were analyzed. All patients underwent primary surgery via triple incision resulting in complete tumor resection. Thirty-three patients received a sentinel-node resection only; all others underwent complete inguino-femoral lymph-node dissection. Median follow-up was 40.5 months. Results: Median age of the patients was 59 years; the majority (88.5%) had pT1b and pT2 tumors with a median size of 16mm (range 1-150mm). The median minimal resection margin was 5mm (range 1-25mm). Twelve patients received adjuvant radiotherapy of the vulva (without the groins or pelvis) because of large primary tumors. Nine patients (8.3%) developed disease recurrence (thereof five at the vulva and four at the groins). Despite patients' age (p=0.035) none of the analyzed clinical parameters (stage, tumor size, invasion depth, tumor grade, hpv status, resection margin distance, adjuvant radiation, mode of groin dissection [sentinel vs. full]) was prognostically relevant for disease-free survival. Conclusions: Despite patients' age, the common prognostic factors of advanced vulvar cancer appear to be irrelevant in patients with node-negative disease. New molecular markers are therefore needed to identify high risk disease in this subset of patients.