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. 2021 Oct;28(11):6696-6704.
doi: 10.1245/s10434-021-09744-y. Epub 2021 Mar 15.

Role of Pelvic Lymph Node Resection in Vulvar Squamous Cell Cancer: A Subset Analysis of the AGO-CaRE-1 Study

Linn Woelber #  1 , Mareike Bommert #  2 , Philipp Harter  2 , Katharina Prieske  3   4 , Christine Zu Eulenburg  5 , Julia Jueckstock  6 , Felix Hilpert  7 , Nikolaus de Gregorio  8 , Severine Iborra  9 , Jalid Sehouli  10 , Atanas Ignatov  11 , Peter Hillemanns  12 , Sophie Fuerst  6 , Hans-Georg Strauss  13 , Klaus Baumann  14 , Matthias Beckmann  15 , Alexander Mustea  16 , Werner Meier  17 , Sven Mahner  6 , Anna Jaeger  3
Affiliations

Role of Pelvic Lymph Node Resection in Vulvar Squamous Cell Cancer: A Subset Analysis of the AGO-CaRE-1 Study

Linn Woelber et al. Ann Surg Oncol. 2021 Oct.

Abstract

Background: As the population at risk for pelvic nodal involvement remains poorly described, the role of pelvic lymphadenectomy (LAE) in vulvar squamous cell cancer (VSCC) has been a matter of discussion for decades.

Methods: In the AGO-CaRE-1 study, 1618 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB or higher primary VSCC treated at 29 centers in Germany between 1998 and 2008 were documented. In this analysis, only patients with pelvic LAE (n = 70) were analyzed with regard to prognosis and correlation between inguinal and pelvic lymph node involvement.

Results: The majority of patients had T1b/T2 tumors (n = 47; 67.1%), with a median diameter of 40 mm (2-240 mm); 54/70 patients (77.1%) who received pelvic LAE had positive groin nodes. For 42 of these 54 patients, the number of affected groin nodes had been documented as a median of 3; 14/42 (33.3%) of these patients had histologically confirmed pelvic nodal metastases (median number of affected pelvic nodes 3 [1-12]). In these 14 patients, the median number of affected groin nodes was 7 (1-30), with a groin metastases median maximum diameter of 42.5 mm (12-50). Receiver operating characteristic analysis showed an area under the curve of 0.85, with 83.3% sensitivity and 92.6% specificity for the prediction of pelvic involvement in cases of six or more positive groin nodes. No cases of pelvic nodal involvement without groin metastases were observed. Prognosis in cases of pelvic metastasis was poor, with a median progression-free survival of only 12.5 months.

Conclusion: For the majority of node-positive patients with VSCC, pelvic nodal staging appears unnecessary since a relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease.

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Figures

Fig. 1
Fig. 1
Prediction of pelvic involvement depending on the number of inguinally affected lymph nodes. ROC receiver operating characteristic
Fig. 2
Fig. 2
Progression-free survival and overall survival with regard to pelvic lymph node status
See this image and copyright information in PMC

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