RT Journal Article SR Electronic T1 Prognostic factors in patients with vulvar cancer: the VULCAN study JF International Journal of Gynecologic Cancer JO Int J Gynecol Cancer FD BMJ Publishing Group Ltd SP ijgc-2019-000526 DO 10.1136/ijgc-2019-000526 A1 Ignacio Zapardiel A1 Sara Iacoponi A1 Pluvio J Coronado A1 Kamil Zalewski A1 Frank Chen A1 Christina Fotopoulou A1 Polat Dursun A1 Ioannis C Kotsopoulos A1 Robert Jach A1 Alessandro Buda A1 Maria J Martinez-Serrano A1 Christoph Grimm A1 Robert Fruscio A1 Enrique Garcia A1 Jacek Jan Sznurkowski A1 Cristina Ruiz A1 Maria C Noya A1 Dib Barazi A1 Javier Diez A1 Begoña Diaz De la Noval A1 Arnoldas Bartusevicius A1 Pierandrea De Iaco A1 Maria Otero A1 Maria Diaz A1 Dimitrios Haidopoulos A1 Silvia Franco A1 Pawel Blecharz A1 Miguel A Zuñiga A1 Patricia Rubio A1 Barbara Gardella A1 Dimitrios C Papatheodorou A1 Yusuf Yildirim A1 Francesc Fargas A1 Ronalds Macuks A1 , YR 2020 UL http://ijgc.bmj.com/content/early/2020/06/22/ijgc-2019-000526.abstract 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.