Long-term survival and disease recurrence in patients with primary squamous cell carcinoma of the vulva

Abstract

Objectives

To assess time to failure and sites of failure with extended follow-up of patients with squamous cell carcinoma (SCC) of the vulva.

Methods.

A retrospective analysis of 330 patients with primary SCC of the vulva treated at Mayo Clinic between 1955 and 1990 was conducted. The main outcome measures were the rates of treatment failure. The Kaplan-Meier method and the log-rank test were used to estimate the rates of overall survival, disease-free survival, and recurrence. The Cox proportional hazards model was used to assess independent variables as prognostic factors for treatment failure.

Results

All 330 patients in the cohort underwent lymphadenectomy; 113 patients (34.2%) had involvement of the inguinofemoral nodes and 88 patients (26.7%) had treatment failure. Treatment failures occurred more frequently in patients who presented with inguinal metastasis at the primary surgery and during the first 2 years of follow-up. After 2 years, both groups, with or without positive inguinal nodes, had similar treatment failure rates. Most patients with disease recurrence in the groin died within the first 2 years of follow-up. Involvement of the inguinal nodes was the main independent predictive factor for survival, disease recurrence, and metastasis.

Conclusions

Most treatment failures occurred during the 2 years after initial surgical management. However, in 35% of patients, disease reoccurred 5 years or more after diagnosis, which demonstrates the need for long-term follow-up. Complete ipsilateral or bilateral inguinofemoral lymph node dissection ensures a thorough evaluation and treatment of the groin.

Introduction

Treatment failures after therapy for squamous cell carcinoma (SCC) of the vulva reflect the biological behavior and patterns of spread of the disease at the time of diagnosis. The distribution of the initial sites of failure after therapy for SCC of the vulva has been extensively studied [1], [2], [3], [4]. The majority of these studies analyzed survival and relapse rates based on statistical estimates at 5 and 10 years [1], [5], [6], [7], but limited information is available about time to failure for vulvar SCC and long-term disease-specific survival exceeding 10 years. An expanded understanding of the natural history of vulvar cancer may facilitate treatment modification, clinical trial design and implementation, outcome analysis, and patient counseling regarding disease surveillance after definitive treatment.

The objective of the present study was to assess time to failure and sites of failure in a cohort of patients with SCC of the vulva with extended follow-up. Secondary objectives were to assess long-term recurrences, reoccurrences, survival rates, and prognostic factors for treatment failure.