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24 Patterns of recurrence in vulvar cancer: a nationwide population-based study
  1. D Zach1,
  2. E Åvall Lundqvist2,
  3. H Åvall Lundqvist1,
  4. J Hemming3,
  5. K Hellman4 and
  6. A Flöter Rådestad5
  1. 1Dept of Gynecological Cancer, Dept of Women’s and Children’s Health, Karolinska University Hospital, Karolinska Institute, Sweden
  2. 2Dept of Oncology and Dept of Biomedical and Clinical Sciences, University Linköping, Sweden
  3. 3Dept of Oncology and Pathology, Karolinska Institute, Sweden
  4. 4Dept of Gynecological Cancer, Dept of Oncology and Pathology,Karolinska University Hospital, Karolinska Institute, Sweden
  5. 5Dept of Hereditary Cancer, Dept of Women’s and Children’s Health,Karolinska University Hospital, Karolinska Institute, Sweden


Objectives To explore patterns of recurrence and prognostic factors in patients with vulvar squamous cell carcinoma (VSCC) in Sweden.

Methods A nationwide population-based retrospective cohort study, including women diagnosed with VSCC between 2012–2015 and registered in the Swedish Quality Registry for Gynecologic Cancer. Further information about recurrences and follow-up was retrieved from medical charts. Prognostic factors (groin surgery; age (> 79 years vs < 65 years), stage (I-II vs III-IV)) for recurrence-free (RFS) and overall survival (OS) were analyzed by multivariate regression models.

Results 489 eligible women were included. Median follow-up was 5.3 years. The overall recurrence rate was 22.3%; in 56% local, in 27.5% groin and in 7.3% distant recurrences. 63.3% of all women with a recurrence reported symptoms. Groin surgery was withheld in 13% of women with presumed stage IB-II.

Poorer RFS and OS was significantly associated with older age (HR 3.44; p<0.001 for RFS; HR 5.03; p<0.001 for OS), withheld groin surgery (withheld versus performed: HR 0.53; p=0.001 for RFS; HR 0.49; p=0.001 for OS) and advanced FIGO stage (HR 2.41; p<0.001 for RFS; HR 2.48; p<0.001 for OS).

Recurrences diagnosed in-between follow-up visitations were significantly larger (30 mm versus 18 mm, p=0.003) but after adjustment for age, type of recurrence and time since treatment not associated with worse survival.

Conclusions This population-based study confirms previous findings of predominantly local recurrences in vulvar cancer. Besides known prognostic factors as age and FIGO-stage, withheld groin surgery was associated with worse RFS and OS.

The value of regular follow-up remains undetermined.

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