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 Zapardiel, Ignacio
A1 Iacoponi, Sara
A1 Coronado, Pluvio J
A1 Zalewski, Kamil
A1 Chen, Frank
A1 Fotopoulou, Christina
A1 Dursun, Polat
A1 Kotsopoulos, Ioannis C
A1 Jach, Robert
A1 Buda, Alessandro
A1 Martinez-Serrano, Maria J
A1 Grimm, Christoph
A1 Fruscio, Robert
A1 Garcia, Enrique
A1 Sznurkowski, Jacek Jan
A1 Ruiz, Cristina
A1 Noya, Maria C
A1 Barazi, Dib
A1 Diez, Javier
A1 Diaz De la Noval, Begoña
A1 Bartusevicius, Arnoldas
A1 De Iaco, Pierandrea
A1 Otero, Maria
A1 Diaz, Maria
A1 Haidopoulos, Dimitrios
A1 Franco, Silvia
A1 Blecharz, Pawel
A1 Zuñiga, Miguel A
A1 Rubio, Patricia
A1 Gardella, Barbara
A1 Papatheodorou, Dimitrios C
A1 Yildirim, Yusuf
A1 Fargas, Francesc
A1 Macuks, Ronalds
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.