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Abstract
Introduction/Background Vulval cancer is a rare gynaecological malignancy. HPV infection and lichen sclerosis are responsible for premalignant lesions. Recurrence occurs in 12–37% of cases. Around 40–80% of recurrences occur within the first two years.
We aimed to examine the recurrence patterns and survival outcomes of vulval SCC in our cancer centre.
Methodology This is a retrospective cohort study of women who received treatment at Oxford University Hospitals between February 2010 and July 2022 for primary vulval squamous cell carcinoma.
Results
We included 98 cases in our study.
The median age at diagnosis was 68 years.
HPV infection and Lichen sclerosis were observed in 21 and 55 respectively.
Surgical excision was the primary treatment. 27 patients had adjuvant treatment (radiotherapy = 19), chemotherapy = 1 and chemoradiotherapy = 7). 16 patients required a secondary operation. 86 cases underwent inguinofemoral lymph node dissection.
Recurrence within 2 years was more common among patients with advanced FIGO stage (p=0.047, RR 2.07) and extracapsular spread of lymph node metastasis (p=0.013, RR 3.33).
Local recurrence in stage I patients was associated with lichen sclerosis (p=0.013), negative HPV status (0.057), margin involvement by VIN (0.004) and proximity of tumour to margin by ≤8mm (p=0.002).
Worse survival outcomes were observed with higher tumour grade (p=0.015), advanced FIGO stage (p<0.001), lymph node involvement (p<0.001, HR 6.39), extracapsular spread (p<0.001, HR 7.67), lymphovascular space invasion (p<0.001, HR 5.16) and perineural invasion (p=0.009, HR 3.34), HPV-independent cancer (p=0.066, HR 3.85), and recurrence (p<0.001, HR 3.79), particularly if it occurred within two years (p<0.001, HR 25.53).
Conclusion
Recurrence within 2 years was associated with advanced stage and extracapsular extension.
Local recurrence was influenced with lichen sclerosis, HPV status, margin status.
Poor survival with higher grade, advanced stage, LN involvement, extracapsular spread, lymphovascular and perineural invasion, HPV-independent cancer, and recurrence.
Disclosures The authors declare no conflict of interest.
This research received no external funding.
