Prognostic value of lymph node ratio in surgically treated cases of vulvar cancer: a tertiary care centre experience

Poddar, Pabashi; Patel, Shilpa M.; Arora, Ruchi; Parekh, Chetana; Dave, Pariseema; Amin, Sangeetha

doi:10.5468/ogs.2020.63.2.158

Cited by 3 publications

(2 citation statements)

References 20 publications

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“… 10 The majority of the recurrences that occurred were locoregional. In a study by Poddar et al, 22 in 61.9% of cases, local recurrence was the most common type, and most of it occurred in patients with initial lymph node metastasis. 22 Furthermore, Singareddy et al 23 showed that the locoregional occurrence rate was 24.5% in the radical surgery group, 12% in the surgery plus radiotherapy group, and 47% in the radical radiotherapy group, whereas the distant metastasis rate was only 4%.…”

Section: Discussionmentioning

confidence: 92%

“…In a study by Poddar et al, 22 in 61.9% of cases, local recurrence was the most common type, and most of it occurred in patients with initial lymph node metastasis. 22 Furthermore, Singareddy et al 23 showed that the locoregional occurrence rate was 24.5% in the radical surgery group, 12% in the surgery plus radiotherapy group, and 47% in the radical radiotherapy group, whereas the distant metastasis rate was only 4%. 21 In our study too, lymph node positivity was found to be an independent risk factor ( P < .05), but the common site of recurrences was distant.…”

Section: Discussionmentioning

confidence: 92%

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The Unmet Needs in the Management of Vulvar Cancer and a Review of Indian Literature

Kaur

Garg

Nandwani

2022

JCO Global Oncology

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PURPOSE This study was undertaken to analyze our cohort of patients with vulvar cancer, the factors affecting their survival, and to review published Indian literature. MATERIALS AND METHODS A prospectively maintained database of 18 patients with vulvar cancer who were amenable to up-front surgery and treated between 2013 and 2021 was analyzed. Patients were studied and evaluated for clinicopathological features, risk factors, stage of disease, surgical modalities, and disease outcome. This study critiques the 16 studies identified in the English literature relating to vulvar carcinoma from 1996 to 2021 from India. RESULTS The mean age of our patients was 63.7 years. All 18 patients underwent up-front radical surgery with primary closure. Postoperative histology was squamous cell carcinoma with negative margins in all and lymph-vascular space involvement negative in 17 of 18 patients. Of the 10 patients who underwent inguinofemoral lymphadenectomy, four patients had positive lymph nodes. The estimated mean survival was 61.6 months. We reviewed the Indian literature for over 25 years. As the majority of patients presented with a locally advanced stage of the disease, the primary mode of treatment was chemoradiotherapy. Lymph node positivity and lack of appropriate management at relapse increased the risk of poor survival. CONCLUSION This review clearly emphasizes the unmet need for more prospective multicentric trials not only to increase our understanding about the disease but also to define better treatment protocols for various stages of the disease, thereby improving disease-free and overall survival.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

The Unmet Needs in the Management of Vulvar Cancer and a Review of Indian Literature

Kaur

Garg

Nandwani

2022

JCO Global Oncology

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Role of Radiation Therapy in the Management of Locally Advanced Vulvar Cancer—15 Years of Experience at a Tertiary Care Center in Southern India

Wilson,

John,

Sathyamurthy

et al. 2024

Indian J Surg Oncol

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Lymph node ratio as an indicator of nodal status in the assessment of survival and recurrence in vulvar cancer: A cohort study

Mansouri,

Zemni,

Sakhri

et al. 2024

Womens Health (Lond Engl)

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Background: Inguinal lymph node (LN) metastasis and particularly the number of metastatic lymph nodes (NMLN) represent a determinant prognostic factor in vulvar squamous cell carcinoma (VSCC). However, the NMLN may be related to the number of removed LNs. Therefore, the lymph node ratio (LNR) reflects not only the burden of LN involvement but also the quality and extent of lymphadenectomy. Objectives: To investigate the value of the LNR and the count of LN on overall survival (OS) and recurrence-free survival (RFS). Design: This study is a retrospective, longitudinal, institution-based study. Methods: This study included 192 patients treated for VSCC at the Salah Azaiez Institute between 1994 and 2022. Clinical, pathological, and evolutionary data were reported. Survival curves were generated by the Kaplan–Meier method, and predictive factors of outcome were analyzed using Cox proportional hazards models. Results: Surgery consisted of a radical vulvectomy, hemivulvectomy, and pelvic exenteration in, respectively, 96.4%, 2.1%, and 1.6% of cases followed by adjuvant radiotherapy in 38.5% of cases. LN dissection was bilateral in 88.5% of cases. LNR = 0, LNR = 0–0.2, and LNR ⩾0.2 were recorded in, respectively, 64.7%, 22.1%, and 13.2% of cases. With a mean follow-up time of 35 ± 42.06 months, the 5-year OS was 52.5% and the 5-year RFS was 55.8%. On multivariate analysis, the independent prognostic factors of OS were the LNR (hazard ratio (HR) = 5.702; 95% confidence interval (CI) = 2.282–14.245; p < 0.0001), Federation of Gynecology and Obstetrics (FIGO) stage (HR = 2.089; 95% CI = 1.028–4.277; p = 0.042), and free margins (HR = 2.247; 95% CI = 1.215–4.155; p = 0.01). Recurrences were recorded in 37.5% of cases. Independent prognostic factors of RFS were the LNR (HR = 2.911; 95% CI = 1.468–5.779; p = 0.002), FIGO stage (HR = 1.835; 95% CI = 1.071–3.141; p = 0.027), and free margins (HR = 2.091; 95% CI = 1.286–3.999; p = 0.003). Conclusion: Surgical margin, FIGO stage, and LNR represent the independent prognostic factors of survival and LNR showed superior prognostic predictive accuracy compared with the revised 2021 FIGO staging system for predicting OS and RFS in VSCC.

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Prognostic value of lymph node ratio in surgically treated cases of vulvar cancer: a tertiary care centre experience

Cited by 3 publications

References 20 publications

The Unmet Needs in the Management of Vulvar Cancer and a Review of Indian Literature

The Unmet Needs in the Management of Vulvar Cancer and a Review of Indian Literature

Role of Radiation Therapy in the Management of Locally Advanced Vulvar Cancer—15 Years of Experience at a Tertiary Care Center in Southern India

Lymph node ratio as an indicator of nodal status in the assessment of survival and recurrence in vulvar cancer: A cohort study

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