Introduction To identify clinical, pathological features and survival predictors of vulvar cancer in patients with no lymph node metastasis.

Methods A retrospective study of 123 patients who were diagnosed and treated for vulvar cancer staged I and II at the Salah Azaiez Institute of Oncology between 1994 and 2022

Results Mean age was 65.61±14.081 years (range, 30–104 years) and median follow-up was 37.84±40.221 months. Surgery was a radical vulvectomy,hemivulvectoy, and pelvic exenteration in respectively 96.7%, 2.4%, and 0.8% of cases. Inguinal Sentinel lymph node (LN) biopsy was performed in 10 cases (8.1%), bilateral inguinofemoral lymphadenectomy (ILND) in 101 cases (81.1%), and unilateral (ILND) in 14 cases (11.4%). The mean tumor size was 38.04±20.45 mm. Tumors were classified as stage pT1a, pT1b, pT2, and pT3 in respectively 4.9%, 81.3%,13%%, and 0.8% of cases. The 5 years overall survival was 64.2% and decreased with advanced age ≥ 70 years (45% vs 74% in patients younger than 70 years, p= 0.014) and with the presence of perineural invasion (PNI) (0% vs 70.7%, p=0.028). The 5-year recurrence-free survival was 65.8% and decreased with a number of retrieved LN less than 12 (0% vs 45.3% in case of 12 or more LN;p=0.001), and the presence of PNI (33.3% vs 71.4%, p=0.002). Moreover, the rate of recurrence increased with the pT stage (0%, 26%, and 52% respectively in stages pT1a, pT1b, and pT2–3;p=0.021).

Conclusion/Implications The survival of patients with stage I and II of vulvar cancer is correlated to the number of retrieved LN and the presence of PNI.