Vulval Cancer: When should I Stop Resecting? Identifying the Factors that Predict Recurrence

Abstract

Abstract Context: Vulval cancer surgery has become more conservative and it is important to understand whether resection margins alone influence recurrence rates or whether other prognostic factors should be considered when planning treatment. Aims: The aim of this study is to define factors that predict vulval cancer recurrence, enabling development of a recurrence prediction model. Settings and Design: This was a Aretrospective descriptive analysis of new vulval squamous cell carcinoma cases in a gynecological oncology center (January 1, 2007 to December 31, 2013). Subjects and Methods: Analysis of tumor characteristics and treatments. Patient outcomes were recorded, identifying recurrences, and subsequent interventions. Statistical Analysis Used: Univariable and multivariable logistic regression tools applied to determine recurrence risk factors. Results: Seventy patients underwent primary vulval surgery. Bilateral groin node dissection was performed in 26/70 (37.1%) cases and unilateral groin node dissection in 9/70 (12.9%) cases. 57/70 (82%) cases had a negative vulval resection margin, with 67% <8-mm margin. 18/70 (26%) patients underwent adjuvant treatment. Overall recurrence rate of 21/70 (30%): 14/70 locally and 7/70 at the groin. Median survival was 84.2 months and median disease-free interval was 19.1 months. Factors that were statistically significant in predicting recurrence were positive groin histology, lymphovascular space invasion (LVSI), and disease stage. Conclusions: We reported a reduction in the size of tumor-free margins at primary excision. The recurrence rate of 30% is within the previously reported range, suggesting that factors aside from resection margin (LVSI, stage, and groin node involvement) are also important in predicting recurrence. These factors should be incorporated into a prediction model when planning adjuvant treatment.