The definition of optimal inguinal femoral nodal dissection in the management of vulva squamous cell carcinoma.

OBJECTIVES

To reject the hypothesis that the number of nodes removed at time of surgical staging for vulva cancer is not an important prognostic factor.

METHODS

Retrospective chart reviews were carried out from 1980-2004 to identify patients with squamous cell vulva carcinoma treated with radical vulvectomy and bilateral inguinal femoral lymph node dissection. Patients' demographics, disease characteristics, the number of lymph nodes removed at surgery, and standard oncologic outcomes were recorded. Cox proportional hazard models were built to model times to clinical progression and death using predictor variables of: age, tumor size and maximum depth of invasion, resection margin status, and total number of nodes removed.

RESULTS

Fifty-eight patients were identified. The median lesion size was 3.5 cm. The median depth of invasion was 7.5 mm. The 20th percentile for total number of lymph nodes removed was 10. Adjuvant radiation therapy was given in 31% of patients. At a median follow-up of 37 months, recurrence was observed in 17 patients (29.3%). Cox regressions showed the total number of nodes removed less than 10 to be the only significantly predictive of shorter time to first progression (HR = 12.88, 95% CI = 1.47-112.89, P = .021) and shorter disease specific survivals (HR = 11.41, 95% CI = 2.21-58.86, P = .004) (HR, hazard ratio; CI, confidence interval).

CONCLUSION

The total number of nodes removed at time of surgical staging is an independent survival prognostic factor. A total of at least 10 nodes from a bilateral dissection can be used to define an optimal evaluation.