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28.11.2016 | Gynecologic Oncology | Ausgabe 5/2017

Annals of Surgical Oncology 5/2017

Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 5/2017
Autoren:
MD Rüdiger Klapdor, MD Peter Hillemanns, MD Linn Wölber, MD Julia Jückstock, MD Felix Hilpert, MD Nikolaus de Gregorio, MD Severine Iborra, MD Jalid Sehouli, MD Anika Habermann, MD Sophie Teresa Fürst, MD Hans Georg Strauß, MD Klaus Baumann, MD Falk Thiel, MD Alexander Mustea, MD Werner Meier, MD Philipp Harter, MD Pauline Wimberger, MD Lars Hanker, MD Barbara Schmalfeldt, MD Ulrich Canzler, MD Tanja Fehm, MD Alexander Luyten, MD Martin Hellriegel, MD Jens Kosse, MD Christoph Heiss, MD Peer Hantschmann, MD Peter Mallmann, MD Berno Tanner, MD Jacobus Pfisterer, MD Barbara Richter, MD Martin Jäger, MD Sven Mahner

Abstract

Purpose

Analyzing the large patient cohort of the multicenter AGO-CaRE-1 study, we compared isolated sentinel lymph node dissection (SLND) with radical lymph node dissection (LND) of the groin in relation to recurrence rates and survival.

Methods

The AGO-CaRE-1 study retrospectively collected data on treatment patterns and follow-up of vulvar cancer patients [International Federation of Gynecology and Obstetrics (FIGO) stage ≥1B] treated at 29 gynecologic cancer centers between 1998 and 2008. This subgroup analysis evaluated the influence of SLND alone on progression-free survival (PFS) and overall survival (OS).

Results

In 487 (63.1%) of 772 included patients with tumors smaller than 4 cm, an LND was performed and no metastatic lymph nodes were detected (LN0). Another 69/772 (8.9%) women underwent SLND alone, showing a negative SLN (SLN0). Tumors in the LN0 group were larger and showed a deeper invasion (LN0 vs. SLN0 tumor diameter: 20.0 vs. 13.0 mm, p < 0.001; depth of invasion: 4.0 vs. 3.0 mm, p = 0.002). After a median follow-up of 33 months (0–156), no significant differences in relation to isolated groin recurrence rates (SLN0 3.0% vs. LN0 3.4%, p = 0.845) were detected. Similarly, univariate 3-year PFS analysis showed no significant differences between both groups (SLN0 82.7% vs. LN0 77.6%, p = 0.230). A multivariate Cox regression analysis, including tumor diameter, depth of invasion, age, grading, and lymphovascular space invasion was performed: PFS [hazard ratio (HR) 0.970, 95% confidence interval (CI) 0.517–1.821] and OS (HR 0.695, 95% CI 0.261–1.849) did not differ significantly between both cohorts.

Conclusion

This subgroup analysis of the large AGO-CaRE-1 study showed similar results for groin LND and SLND alone with regard to recurrence rates and survival in node-negative patients with tumors <4 cm.

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