Outcome and Patterns of Recurrence for International Federation of Gynecology and Obstetrics (FIGO) Stages I and II Squamous Cell Vulvar Cancer

Gynaecological Cancer Centre, Royal Hospital for Women and University of New South Wales, Sydney, Australia.
Obstetrics and Gynecology (Impact Factor: 5.18). 05/2009; 113(4):895-901. DOI: 10.1097/AOG.0b013e31819b413f
Source: PubMed


To study patterns of recurrence, to evaluate pathologic features correlating with recurrence, and to estimate the prognostic implications for each different pattern of recurrence in the International Federation of Gynecology and Obstetrics (FIGO) stages I and II squamous cell vulvar cancer.
This was a retrospective study of 121 cases of vulvar cancer managed at our institution from 1987 to 2005. Time to recurrence, sites of local and distant recurrence, and the type of surgery were recorded. Relapse-free and overall survival were calculated.
There was no difference in recurrence rates, time to recurrence, or survival between patients with FIGO stages I or II disease. The 5-year actuarial survival (corrected for competing risks) for stage I disease was 97% compared with 95% for stage II (P=.83). Progression-free survival at 5 years was 86% for stage I and 94% for stage II.In this study, 95.9% of patients were treated with vulvar-conserving surgery without detriment with respect to recurrence or survival.
Vulvar-conserving surgery, even for large tumors, results in excellent outcomes. Vulvar recurrences have an excellent prognosis, but primary site and remote site vulvar recurrences are biologically different. There is no justification for the FIGO differentiation of node-negative cancers confined to the vulva on the basis of tumor size.

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    • "Since the publication of these two seminal trials the SN procedure has been integrated in the standard treatment of pre-selected patients with earlystage vulvar carcinoma world-wide [3]. Previous retrospective studies indicate that 20–23% of all patients with vulvar cancer will have a local recurrence [4] [5] [6]. Treatment of a local recurrence in general is with curative intent and most often will consist of wide local excision. "

    Gynecologic Oncology 09/2015; DOI:10.1016/j.ygyno.2015.09.077 · 3.77 Impact Factor
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    • "In contrast, Routzier et al. [19] did not find the margins of resection a significant risk factor for local recurrences as well as Groenen et al. [17] with a cut-off at 8 mm. Tantipalakorn et al. [20] described also same recurrence rates and OS related to free margins groups. In our study, we did not find significant differences at 8 mm. "
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    ABSTRACT: To analyze the prognostic factors related to the recurrence rate of vulvar cancer. Retrospective study of 87 patients diagnosed of vulvar squamous cell carcinoma diagnosed at a tertiary hospital in Madrid between January 2000 and December 2010. The pathological mean tumor size was 35.1±22.8 mm, with stromal invasion of 7.7±6.6 mm. The mean free margin after surgery was 16.8±10.5 mm. Among all patients, 31 (35.6%) presented local recurrence (mean time 10 months; range, 1 to 114 months) and 7 (8%) had distant metastases (mean time, 5 months; range, 1 to 114 months). We found significant differences in the mean tumor size between patients who presented a relapse and those who did not (37.6±21.3 mm vs. 28.9±12.1 mm; p=0.05). Patients with free margins equal or less than 8 mm presented a relapse rate of 52.6% vs. 43.5% of those with free margin greater than 8 mm (p=0.50). However, with a cut-off of 15 mm, we observed a local recurrence rate of 55.6% vs. 34.5%, respectively (p=0.09). When the stromal invasion cut-off was >4 mm, local recurrence rate increased up to 52.9% compared to 37.5% when the stromal invasion was ≤4 mm (p=0.20). Tumor size, pathologic margin distance and stromal invasion seem to be the most important predictors of local vulvar recurrence. We consider the cut-off of 35 mm of tumor size, 15 mm tumor-free surgical margin and stromal invasion >4 mm, high risk predictors of local recurrence rate.
    Journal of Gynecologic Oncology 07/2013; 24(3):242-8. DOI:10.3802/jgo.2013.24.3.242 · 2.49 Impact Factor
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    • "The risk of additional metastases when only isolated tumour cells are present in the sentinel LN is 4% [55]. Still, approximately 12% of early-stage VC patients with a negative sentinel LN develop local recurrence” [54,56]. "
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    ABSTRACT: Regional lymph node (LN) status is a well-known prognostic factor for vulvar carcinoma (VC) patients. Although the reliable LN assessment in VC is crucial, it presents significant diagnostic problems. We aimed to identify specific mRNA markers of VC dissemination in the LN and to address the feasibility of predicting the risk of nodal recurrence by the patterns of gene expression. Sentinel and inguinal LN samples from 20 patients who had undergone surgery for stage T(1-3), N(0-2), M(0) primary vulvar squamous cell carcinoma were analyzed. Gene expression profiles were assessed in four metastatic [LN(+)] and four histologically negative [LN(-)] lymph node samples obtained from four VC patients, by the Affymetrix U133 Plus 2.0 gene expression microarrays. Of the set of genes of the highest expression in the metastatic LNs compared to LN(-), seven candidate marker genes were selected: PERP, S100A8, FABP5, SFN, CA12, JUP and CSTA, and the expression levels of these genes were further analyzed by the real-time reverse transcription polymerase chain reaction (qRT-PCR) in 71 LN samples. All of the seven genes in question were significantly increased in LN(+) compared to LN(-) samples. In the initial validation of the seven putative markers of metastatic LN, the Cox proportional hazard model pointed to SFN, CA12 and JUP expression to significantly relate to the time to groin recurrence in VC patients. Our findings first provided evidence that SFN, CA12 and JUP have a potential of marker genes for the prediction of the groin recurrence LN in VC patients.
    BMC Cancer 06/2012; 12(1):223. DOI:10.1186/1471-2407-12-223 · 3.36 Impact Factor
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