Associated Lichen Sclerosis Increases the Risk of Lymph Node Metastases of Vulvar Cancer

Abstract

The most important prognostic factor in vulvar cancer is inguinal lymph node status at the time of diagnosis, even in locally advanced vulvar tumors. The aim of our study was to identify the risk factors of lymph node involvement in these women, especially the impact of lichen sclerosis (LS). We conducted a retrospective population-based cross-sectional study in two French referral gynecologic oncology institutions. We included all women diagnosed with a primary invasive vulvar cancer. Epithelial alteration adjacent to the invasive carcinoma was found in 96.8% (n = 395). The most frequently associated was LS in 27.7% (n = 113). In univariate analysis, LS (p = 0.009); usual type VIN (p = 0.04); tumor size >2 cm and/or local extension to vagina, urethra or anus (p < 0.01), positive margins (p < 0.01), thickness (p < 0.01) and lymphovascular space invasion (LVSI) (p < 0.01) were significantly associated with lymph node involvement. In multivariate analysis, only LS (OR 2.3, 95% CI [1.2–4.3]) and LVSI (OR 5.6, 95% CI [1.7–18.6]) remained significantly associated with positive lymph node. LS was significantly associated with older patients (p = 0.005), anterior localization (p = 0.017) and local extension (tumor size > 2 cm: p = 0.001). LS surrounding vulvar cancer is an independent factor of lymph node involvement, with local extension and LVSI.

Data Set for the Reporting of Carcinomas of the Vulva: Recommendations From the International Collaboration on Cancer Reporting (ICCR)

“…Lymphovascular invasion is an adverse prognostic factor associated with increased risk of local recurrence, lymph node metastasis, and poorer survival in vulval SCC (40)(41)(42)(43). Two recent systematic reviews have highlighted some conflicting data on the prognostic significance of lymphovascular invasion from different studies (34,44), but it should be noted that the criteria for lymphovascular invasion were often not specified and there might be substantial variability in terms of diagnostic thresholds.…”