Introduction/Background The aim of this study was to investigate the prognostic value of lymph node ratio (LNR) in patients with vulvar cancer (VC).

Methodology We retrospectively included 192 patients treated for VC at the Salah Azaiez Institute between 1994 and 2022. LNR was stratified into 2 groups: LNR <0.2 and LNR ≥0.2. We analyzed survival rates and studied the correlation between LNR and clinical and pathological factors.

Results The mean age was 64.93± 13.817 years (range, 24–104 years). Surgery consisted of a radical vulvectomy, hemivulvectoy, and pelvic exenteration in respectively 96.4%, 2.1%, and 1.6% of cases. Lymph node (LN) dissection was bilateral in 88.5% of cases and the mean number of retrieved lymph LN was 14. The mean tumor size was 42.21± 24.018 mm. LN metastasis was assessed in 67 patients (34.9%). Tumors were classified as stage FIGO I, II, III, and IV in 55.2%, 9.4%, 32.8%, and 2.6% of cases respectively. LNR<0.2 and ≥0.2 were recorded in respectively 86.9% and 13.2% of cases. On univariate analysis, LNR>0.2 was correlated to tumor grade (30% in grades 2 and 3 vs 11.3% in grade 1, p=0.021), the tumor size (19.4% in tumor>40mm vs 9.3% in the others, p=0.045), the presence of lymphovascular space invasion (66.7% vs 15.7%,p=0.021) and perineural invasion (46.7% vs 12.5%,p=0.001). With a mean follow-up time of 35.48±35.48 months, the 5-year overall survival (OS) in patients with LNR<0.2 and LNR≥0.2 was 58.5% and 11.6% respectively (p<0.0001) and the 5-year free survival (RFS) was 60.3% and 20.5%, respectively (p<0.0001). On multivariate analysis, LNR was an independent prognostic factor of OS (HR=5.702, 95% confidence interval CI= 2.282–14.245, p<0.0001) and RFS (HR=2.911, 95% CI= 1.468–5.779, p=0.002).

Conclusion LNR is associated with an aggressive tumor and represents an independent prognostic factor of both OS and RFS

Disclosures NO CONFLICT of interest