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. 2021 Jul 26:11:676038.
doi: 10.3389/fonc.2021.676038. eCollection 2021.

Safety and Benefit Of Sentinel Lymph Nodes Biopsy Compared to Regional Lymph Node Dissection in Primary Vulvar Cancer Patients Without Distant Metastasis and Adjacent Organ Invasion: A Retrospective Population Study

Weili Zhou  1 , Yang Bai  1 , Yangyang Yue  2
Affiliations

Safety and Benefit Of Sentinel Lymph Nodes Biopsy Compared to Regional Lymph Node Dissection in Primary Vulvar Cancer Patients Without Distant Metastasis and Adjacent Organ Invasion: A Retrospective Population Study

Weili Zhou et al. Front Oncol. .

Abstract

Background: The safety and benefit of sentinel lymph node biopsy (SLNB) compared with regional lymph node dissection (RLND) and no lymph nodes removed (NA) in patients with vulvar squamous cell cancer (VSCC) was not well studied.

Methods: A retrospective analysis on VSCC patients without distant metastasis and adjacent organ invasion from the Surveillance, Epidemiology, and End Results Program database between 2004 and 2016 was carried out. Within subgroups stratified by negative (LN-) or positive (LN+) regional lymph node findings, inverse probability weighting (IPW) adjusted multivariate Fine-Gray compete risk (CR) model and accelerated failure time (AFT) model was used to investigate the factors associated with and cancer-specific survival (CSS) and overall survival (OS).

Results: Of the 3,161 VSCC patients treated with surgery, 287 (9.1%) underwent SLNB, 1,716 (54.3%) underwent RLND, and 1,158 (36.6%) had no regional lymph nodes removed. As illustrated by IPW adjusted multivariate regressions, SLNB was significantly associated with prolonged CSS (LN-, adjusted sub-proportional hazard ratio [sHR] = 0.42; 95% confidence interval [CI], 0.19-0.93; P=0.032; LN+, adjusted sHR = 0.29; 95% CI, 0.16-0.54, P<0.001) and OS (LN-, adjusted time ratio [TR] = 1.38; 95% CI, 0.82-2.32; P=0.226; LN+, adjusted TR = 2.68; 95% CI, 1.73-4.14; P<0.001), although the effect of SLNB on OS was not significant within the LN- cohort. Moreover, SLNB led to improved CSS (adjusted sHR = 0.40; 95% CI, 0.23-0.70; P = 0.001) and OS (adjusted TR=1.15, 95% CI 0.76-1.73, P=0.279) compared with NA. Age was a significant prognostic factor of CSS and OS, whereas tumor size, surgery type, and invasion depth were not.

Conclusions: SLNB leads to significantly prolonged CSS and OS in VSCC surgery patients without distant metastasis and adjacent organ invasion than RLND, except for the similar OS in the LN- cohort. SLNB could be carried out preferentially for VSCC surgery patients without distant metastasis and adjacent organ invasion, irrespective of tumor size, surgery type, invasion depth, and regional lymph nodes metastasis. Further prospective clinical trials are warranted to confirm the findings of this study.

Keywords: age; invasion depth; regional lymph node dissection; sentinel lymph node biopsy; surgery; tumor size; vulvar cancer.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the patient selection procedure. AJCC, American Joint Committee on Cancer; SLNB, sentinel lymph node biopsy; RLND, regional lymph node dissection; NA, no regional lymph node removed.
Figure 2
Figure 2
Overall survival and cancer-specific survival curves after inverse probability weighting. (A) overall survival within the LN− cohort; (B) overall survival within the LN+ cohort; (C) cancer-specific survival within the LN− cohort; (D) cancer-specific survival within the LN+ cohort. LN−, negative regional lymph node findings; LN+, positive regional lymph node findings.
Figure 3
Figure 3
Forest plot of compete-risk subdistribution hazard ratios (sHR) of cancer-specific survival. sHR, subdistribution hazard ratios; SLNB, sentinel lymph node biopsy; RLND, regional lymph node dissection; NA, no regional lymph node removed.
Figure 4
Figure 4
Forest plot of time ratios (TR) of overall survival. TR, time ratio; SLNB, sentinel lymph node biopsy; RLND, regional lymph node dissection; NA, no regional lymph node removed.
See this image and copyright information in PMC

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