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KMID : 1137020220330020013
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Journal of Gynecologic Oncology
2022 Volume.33 No. 2 p.13 ~ p.13
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An evaluation of prognostic factors, oncologic outcomes, and management for primary and recurrent squamous cell carcinoma of the vulva
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Li Jessie Y.
Arkfeld Christopher K.
Tymon-Rosario Joan
Webster Emily
Schwartz Peter E.
Damast Shari
Menderes Gulden
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Abstract
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Objective: To evaluate prognostic factors, outcomes, and management patterns of patients treated for squamous cell carcinoma of the vulva.
Methods: One hundred sixty-four women were retrospectively identified with primary squamous cell carcinoma of the vulva treated at our institution between 1/1996?12/2018. Descriptive statistics were performed on patient, tumor, and treatment characteristics. The χ2 tests and t-tests were used to compare categorical variables and continuous variables, respectively. Recurrence free survival (RFS), overall survival (OS), and disease-specific survival (DSS) were analyzed with Kaplan-Meier estimates, the log-rank test, and Cox proportional hazards.
Results: Median follow-up was 52.5 months. Five-year RFS was 67.9%, 60.0%, 42.1%, and 20.0% for stage I?IV, respectively. Five-year DSS was 86.2%, 81.6%, 65.0%, and 42.9% for stage I?IV, respectively. On multivariate analysis, positive margins predicted overall RFS (hazard ratio [HR]=3.55; 95% confidence interval [CI]=1.18?10.73; p=0.025), while presence of lichen sclerosus on pathology (HR=2.78; 95% CI=1.30?5.91; p=0.008) predicted local RFS. OS was predicted by nodal involvement (HR=2.51; 95% CI=1.02?6.13; p=0.043) and positive margins (HR=5.19; 95% CI=2.03?13.26; p=0.001). Adjuvant radiotherapy significantly improved RFS (p=0.016) and DSS (p=0.012) in node-positive patients. Median survival after treatment of local, groin, and pelvic/distant recurrence was 52, 8, and 5 months, respectively.
Conclusion: For primary treatment, more conservative surgical approaches can be considered with escalation of treatment in patients with concurrent precursor lesions, positive margins, and/or nodal involvement. Further studies are warranted to improve risk stratification in order to optimize treatment paradigms for vulvar cancer patients.
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KEYWORD
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Vulvar Cancer, Squamous Cell Carcinoma, Lichen Sclerosus, Radiotherapy
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