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The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study.

ABSTRACT: For the last 30 years at the Royal Hospital for Women, unifocal vulvar squamous cancers have been treated by radical local excision, aiming to achieve a histopathological margin of ?8 mm, equating to a surgical margin of 1 cm. The need for a margin of this width has recently been challenged. We aimed to determine the long-term outcome following this conservative approach, and the relationship between vulvar recurrences and surgical margins. Data were obtained retrospectively on 345 patients treated primarily with surgery for squamous vulvar cancer between 1987 and 2017. Median follow-up was 93 months. Five-year disease-specific survival was 86%. Of 78 vulvar recurrences, 33 (42.3%) were at the primary site and 45 (57.7%) at a remote site. In multivariable analysis, a margin < 5 mm showed a higher risk of all vulvar (Hazard ratio (HR), 2.29; CI, 1.12-4.70), and primary site recurrences (subdistribution hazard ratio (SHR), 15.20; CI, 5.21-44.26), while those with a margin of 5 to <8 mm had a higher risk of a primary site recurrence (SHR, 8.92; CI, 3.26-24.43), and a lower risk of remote site recurrence. Excision margins < 8 mm treated by re-excision or radiation therapy had a significantly decreased risk of recurrence. Guidelines should continue to recommend a surgical margin of 1 cm.

SUBMITTER: Barlow EL

PROVIDER: S-EPMC7697402 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study.

Barlow Ellen L EL Jackson Michael M Hacker Neville F NF

Cancers 20201114 11

For the last 30 years at the Royal Hospital for Women, unifocal vulvar squamous cancers have been treated by radical local excision, aiming to achieve a histopathological margin of ≥8 mm, equating to a surgical margin of 1 cm. The need for a margin of this width has recently been challenged. We aimed to determine the long-term outcome following this conservative approach, and the relationship between vulvar recurrences and surgical margins. Data were obtained retrospectively on 345 patients trea ...[more]

PMID: 33202675

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Project description:BackgroundVulvar carcinoma is a rare gynecological malignancy. The most commonly used staging system for vulvar cancer is the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system. Nevertheless, it does not incorporate many indispensable prognostic parameters, which prominently influence vulvar cancer patient survival. Thus, the development of a prediction model for evaluating survival prognosis in postoperative vulvar squamous cell cancer patients is of vital importance.MethodsData from 2,166 patients with pathologically confirmed diagnosis of vulvar squamous cell carcinoma from 2004 to 2015 were acquired from the Surveillance, Epidemiology, and End Results (SEER) database. Thirty percent of the patients were randomly assigned to the validation group, and the remainder were used to develop the nomogram. Parameters that significantly correlated with overall survival (OS) were used to create the nomogram. Concordance index (C-index), calibration curve, and decision curve analysis (DCA) were used to assess the predictive accuracy and discriminability of the nomogram model. Additionally, the C-index and DCA of the nomogram and the FIGO staging system were compared.ResultsFollowing multivariate analysis of the training cohort, independent factors for OS, including race, age at diagnosis, marital status, FIGO stage, tumor diameter, and lymph node ratio (LNR), were included in the nomogram model. The calibration curve indicated a high correlation between the nomogram-predicted and observed survival probability. The C-index of the nomogram in the training cohort was 0.772 (95% CI: 0.752-0.792), statistically superior to the C-index value of the FIGO staging system (0.676, 95% CI: 0.654-0.698). In DCA, compared to the FIGO staging system, this nomogram showed a greater net benefit and a wider range of threshold probability. Results were verified by an internal validation cohort.ConclusionsOur nomogram, based on LNR, showed superior prognostic predictive accuracy compared with the FIGO staging system for predicting OS in postoperative vulvar squamous cell carcinoma patients.

Dataset Information

The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study.

Publications

The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study.

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