PT  - JOURNAL ARTICLE
AU  - Zapardiel, Ignacio
AU  - Iacoponi, Sara
AU  - Coronado, Pluvio J
AU  - Zalewski, Kamil
AU  - Chen, Frank
AU  - Fotopoulou, Christina
AU  - Dursun, Polat
AU  - Kotsopoulos, Ioannis C
AU  - Jach, Robert
AU  - Buda, Alessandro
AU  - Martinez-Serrano, Maria J
AU  - Grimm, Christoph
AU  - Fruscio, Robert
AU  - Garcia, Enrique
AU  - Sznurkowski, Jacek Jan
AU  - Ruiz, Cristina
AU  - Noya, Maria C
AU  - Barazi, Dib
AU  - Diez, Javier
AU  - Diaz De la Noval, Begoña
AU  - Bartusevicius, Arnoldas
AU  - De Iaco, Pierandrea
AU  - Otero, Maria
AU  - Diaz, Maria
AU  - Haidopoulos, Dimitrios
AU  - Franco, Silvia
AU  - Blecharz, Pawel
AU  - Zuñiga, Miguel A
AU  - Rubio, Patricia
AU  - Gardella, Barbara
AU  - Papatheodorou, Dimitrios C
AU  - Yildirim, Yusuf
AU  - Fargas, Francesc
AU  - Macuks, Ronalds
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.