Introduction To identify the prognostic factors correlated to the overall survival (OS) and recurrence-free survival (RFS) in vulvar cancer (VC).

Methods We retrospectively included 192 patients treated for VC at the Salah Azaiez Institute between 1994 and 2022. Clinical, pathological, and evolutionary data were reported. Survival curves were generated by the Kaplan-Meier method and predictive factors of outcome were analyzed using Cox proportional hazards models.

Results The mean age was 64.93± 13.817 years. Surgery consisted of a radical vulvectomy, hemivulvectoy, and pelvic exenteration in respectively 96.4%, 2.1%, and 1.6% of cases followed by adjuvant radiotherapy in 38.5% of cases. Lymph node (LN) dissection was bilateral in 88.5% of cases. The mean tumor size was 42.21± 24.018 mm. LN metastasis was assessed in 67 patients (34.9%). Lymph node ratio LNR=0, LNR0–0.2, and LNR≥0.2 were recorded in respectively 64.7%,22.1%, and 13.2% of cases. Tumors were classified as stage FIGO I, II, III, and IV in 55.2%, 9.4%, 32.8%, and 2.6% of cases respectively. With a mean follow-up time of 35.48±35.48 months, the 5-year OS was 52.5% and the 5-year RFS was 55.8%. On multivariate analysis, the independent prognostic factor of OS was the LNR (HR=5.702; 95% CI= 2.282–14.245;p<0.0001), FIGO stage (HR=2.089; 95% CI=1.028–4.277;p=0.042) and free margins R0(HR=2.247; 95% CI=1.215–4.155;p=0.01). Recurrence was recorded in 37.5% of cases. Independent prognostic factor of RFS were the LNR (HR=2.911;95% CI=1.468–5.779;p=0.002),FIGO stage (HR=1.835;95% CI=1.071–3.141;p=0.027) and free margins (HR=2.091; 95% CI=1.286–3.999;p=0.003).

Conclusion/Implications LNR, FIGO stage, and complete resection were the independent prognostic factors of survival and recurrence in VC.