Introduction/Background To evaluate risk factors associated with adverse oncological outcomes in women undergoing primary surgery for vulvar cancer.
Methodology Eighty-one patients who underwent primary surgery for SCC vulva and were registered at tertiary cancer hospital between January 2011- December 2018 were analysed retrospectively. Adverse risk factors such as age, stage, tumour free margins (TFM), depth of stromal invasion (DSI) and lymph node status were analysed using univariate analysis and survival was calculated using Kaplan-Meir curves.
Results Median age was 55 years. All patients underwent either wide radical excision/radical vulvectomy. Groins were addressed in 63 patients. Median follow up was 42 months. Overall survival and DFS at 3 years were 82% and 69% respectively. On univariate analysis of 81 patients, DSI, TFM (<10 mm) and stage III> had statistically significant effect on DFS, whereas DSI and stage III> had statistically significant effect on overall survival. Age >60 years did not have significant effect on oncological outcomes.
Following surgery, based on final histology report, 63 patients remained within stage I/II, whereas 18 patients were upstaged to Stage III & above (Stage III>). Stage migration was mainly due to lymph node positivity on histology.
On subgroup analysis of 63 patients in good prognostic group (stage 1/II), DFS and TFM had statistically significant adverse effects on DFS and OS. Overall survival at 3 years was 86% and DFS 78% in this subgroup.
Of 18 patients in poor prognostic subgroup (post-surgical stage III and above), 1 in 3 developed recurrence and 1 in 2 died of disease.
Conclusion There is a positive correlation of DSI and lymphnode metastasis, hence lymphadenectomy is proposed based on DSI subcategory in FIGO stage I. Our study found DSI as an independent risk factor which affects both DFS and overall survival in early stage vulvar cancer with negative lymph nodes.
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