PT - JOURNAL ARTICLE AU - Ignacio Zapardiel AU - Sara Iacoponi AU - Pluvio J Coronado AU - Kamil Zalewski AU - Frank Chen AU - Christina Fotopoulou AU - Polat Dursun AU - Ioannis C Kotsopoulos AU - Robert Jach AU - Alessandro Buda AU - Maria J Martinez-Serrano AU - Christoph Grimm AU - Robert Fruscio AU - Enrique Garcia AU - Jacek Jan Sznurkowski AU - Cristina Ruiz AU - Maria C Noya AU - Dib Barazi AU - Javier Diez AU - Begoña Diaz De la Noval AU - Arnoldas Bartusevicius AU - Pierandrea De Iaco AU - Maria Otero AU - Maria Diaz AU - Dimitrios Haidopoulos AU - Silvia Franco AU - Pawel Blecharz AU - Miguel A Zuñiga AU - Patricia Rubio AU - Barbara Gardella AU - Dimitrios C Papatheodorou AU - Yusuf Yildirim AU - Francesc Fargas AU - Ronalds Macuks ED - , TI - Prognostic factors in patients with vulvar cancer: the VULCAN study AID - 10.1136/ijgc-2019-000526 DP - 2020 Jun 22 TA - International Journal of Gynecologic Cancer PG - ijgc-2019-000526 4099 - http://ijgc.bmj.com/content/early/2020/06/22/ijgc-2019-000526.short 4100 - http://ijgc.bmj.com/content/early/2020/06/22/ijgc-2019-000526.full AB - Objective This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer.Methods This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed.Results After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget’s disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05).Conclusions Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.