Introduction/Background Vulvar cancers accounts for 3–5% of all gynaecological malignancies. Inguinal lymph node involvement and tumour-free margin are considered as significant prognostic factors for survival in patients with vulvar cancer. Surgery is the cornerstone of treatment. Lymph node ratio (LNR) is the ratio of the number of positive lymph nodes (LN) to the number of removed LN. This parameter incorporates not only the burden of nodal disease and cancer spread but also the extent and quality of surgical staging. Current data in the literature regarding a minimum oncologically safe tumour-free margin distance are contradictory. The objective of this study was to evaluate the association of tumour-free margin and LNR with oncologic outcomes in vulvar cancer.
Methodology Retrospective analysis evaluating 21 patients of vulvar squamous cell cancer who underwent primary surgery at our institution from January 2013 to December 2018. Patients were stratified into three risk groups according to tumour-free margin (<5 mm, ≥5 mm - <8 mm and ≥8 mm) and LNR (0%, >0–20% and >20%) to compare oncologic outcomes. Follow up was done till August 2019. Qualitative variables were correlated using Chi-Square test/Fisher’s exact test. Overall survival (OS), disease free survival (DFS) and recurrence rate (RR) were estimated by Kaplan-Meier method. Log rank test was used for comparison among the groups.
Results Median age was 67 years. Median DFS and OS were 17.4 months and 27.7 months respectively. 11 patients (52.4%) developed recurrence of which 8 had local recurrence. RR in tumour-free margin <5 mm group was high (100%) as compared to ≥5 mm - <8 mm (50%) and ≥8 mm (30%) groups (p=0.037). DFS rates at the end of the study were increasing from 0.0% (in <5 mm group) to 66.7% (in ≥8 mm group) and as well OS rates also (50% to 65.6%). At the end of the study DFS rates in patients with LNR 0%, >0-<20% and ≥20% were 57.1%, 22.5% and 0.0% respectively (p=0.047). On applying Log rank test no significant difference was seen in the OS between the different groups of LNR.
Conclusion Prognosis of vulvar cancer patient is affected by tumour-free margin and high LNR in our study. DFS is significantly reduced in patients with tumour-free margin <5 mm even in the absence of LN metastasis. High LNR is associated with unfavourable DFS. Tumour-free margin ≥8 mm is a good prognostic factor in patients of vulvar carcinoma.
Disclosures This study received no external funding and sponsorship. The authors declare no conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.