Impact of Inguinal Dissection on Prognosis of Early-Stage Squamous Cell Carcinoma of the Vulva – a Retrospective Analysis

Abstract

Background: Inclusion of inguinal lymphadenectomy in the surgical procedure is a potential prognostic factor for squamous cell vulvar carcinoma. Patients and Methods: A total of 33 women with early-stage squamous cell vulvar carcinoma were analyzed retrospectively. Before the establishment of FIGO criteria in 1983, 17 patients with stage I and 2 patients with stage II were evaluated clinically without inguinal lymphadenectomy. All patients underwent post-operative radiotherapy with a median dose of 45 Gy to the pelvis (vulva included) and boost dose to the vulva ranging from 10 to 20 Gy. Factors assessed for prognostic value included age, inguinal lymph node dissection, differentiation grade, and total irradiation dose to the vulva and pelvis. Results: The log-rank test and the univariate regression analysis revealed that all above factors except irradiation dose decreased the overall survival. In the multivariate regression analysis, differentiation grade and the absence of inguinal dissection were independent predictors for decreased survival with a relative risk up to 2.6 (95% CI = 1.3, 5.6) and 2.7 (95% CI = 1.31, 5.44), respectively. Conclusion: Clinical evaluation of inguinal lymph node involvement is inadequate and node dissection is definitely the only appropriate surgical procedure for vulvar carcinoma.

Treatment Results and Prognostic Factors of Patients with Vulvar Cancer Treated with Postoperative or Definitive Radiotherapy

“…Differentiation of the tumor (low [grade 1] vs poor [grade 2-3]) was found as an important prognostic factor in multivariate analyses (for MVA: HR 1-3.11, 95% CI 1.6-4.62, p = 0.0057). Other retrospective data including 33 patients with vulvar cancer found that differentiation grade was an independent predictor for decreased survival with a relative risk up to 2.6 (95% CI 1.3, 5.6) (13).…”

Prognostic analysis of early-stage squamous cell carcinoma of the vulva

“…Early stage vulvar squamous cell carcinoma confirmed no inguinal lymph node metastasis pathologically, but a 11% to 43% probability of lymph node micrometastasis exists [9]; Gonzalez and Bosquet reported a retrospective study of 320 patients with vulvar cancer who had undergone surgery; of all 214 cases without suspicious inguinal lymph node metastasis, 48 patients (22.4%) exhibited occult lymph node metastases [10]. In these cases it is necessary to resect the bilateral inguinal lymph node.…”

Lymphadenektomie der Leisten- und Beckenregion

“…bestand nicht [1]. Allerdings stellt die sauber ausgeführte inguinale Lymphknotendissektion einen positiven Prognosefaktor bei der chirurgischen Therapie des Vulvakarzinoms dar [17]. Analog dazu ist ein inguinales Lymphknotenrezidiv oder die bilaterale Metastasierung jeweils mit einer schlechteren Prognose behaftet [11].…”