Abstract
PurposeTo investigate patient-reported quality of life (QoL) and associated factors in vulvar cancer patients treated surgically by vulvar field resection (VFR) without adjuvant radiation.MethodsWe retrospectively evaluated patient-reported QoL as part of the prospective monocentric VFR trial using the 30-item European Organization for Research and Treatment of Cancer quality-of-life questionnaire (EORTC QLQ-C30) supplemented by a question assessing sexual activity. All patients had been treated by VFR and no participant had received adjuvant radiotherapy. The gynecologic cancer lymphedema questionnaire (GCLQ) was used to determine the presence of lymphedema. Structured telephone interviews were conducted to assess postoperative sequelae and long-term complications.ResultsForty-three VFR patients (median age 63 years) were available for QoL assessment. Thirty-eight (88%) had received inguinal lymph-node dissection in addition to VFR. Mean global QoL (global health status) rating among all patients was 66.1 (± 25.5) on a scale from 0 to 100 with higher scores indicating better QoL. Higher GCLQ scores were significantly associated with lower global QoL scores (Spearman's rank correlation ρ =− 0.7, p < 0.0001). The presence of preoperative co-morbidities and postoperative wound-healing complications were also linked to reduced QoL (p < 0.01 for both). In a multivariable regression model, there was a significant interaction between preoperative co-morbidities and wound-healing complications with regard to global QoL (p < 0.05).ConclusionOverall, VFR patients exhibit good quality of life postoperatively. The presence of lymphedema, wound-healing complications, and preoperative morbidities were associated with reduced QoL. Prospective longitudinal studies have to confirm our findings in the future.
Highlights
Vulvar cancer accounts for about 5% of all malignancies of the female genital tract [1, 2]
Two patients had to be excluded from the study because they had received postoperative radiotherapy violating the study protocol
Forty-one EORTC QLQ-C30 forms were fully completed, while missing values had to be imputed in two cases as outlined in the methods section
Summary
Vulvar cancer accounts for about 5% of all malignancies of the female genital tract [1, 2]. While in some anatomic regions, this approach necessitates resection margins wider than 8 mm, other tissues directly abutting the tumor but belonging to a different ontogenetic domain can be preserved as they are not at risk for tumor involvement even when they are in close spatial proximity (< 8 mm). This facilitates optimal anatomic reconstruction by sparing important flap-donation tissues such as the labia majora in most cases and minimizes morbidity. We have already demonstrated excellent surgical and oncological outcomes achieved in the monocentric prospective Leipzig VFR trial [8] In this trial, 97 consecutive patients were included of which 40% had lymph-node metastases and 36% had stage II disease or higher. Because lymphedema of the lower extremities is one of the most prevalent and disturbing sequelae in vulvar cancer survivors, we here report its presence in VFR patients and investigate its correlation with QoL
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