L S Nooij1, M A van der Slot2, O M Dekkers3, T Stijnen4, K N Gaarenstroom5, C L Creutzberg6, V T H B M Smit2, T Bosse2, M I E van Poelgeest7. 1. Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands. 2. Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands. 3. Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands. 4. Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands. 5. Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands. 6. Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands. 7. Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: M.I.E.van_Poelgeest@lumc.nl.
Abstract
BACKGROUND: There is no consensus on the width of tumour-free margins after surgery for vulvar squamous cell carcinoma (VSCC). Most current guidelines recommend tumour-free margins of ≥8 mm. The aim of this study was to investigate whether a margin of <8 mm is associated with an increased risk of local recurrence in VSCC. METHODS: A meta-analysis of the available literature and a cohort study of 148 VSCC patients seen at a referral centre from 2000 to 2012 was performed. The primary end-point of the cohort study was a histologically confirmed ipsilateral local recurrence within 2 years after primary treatment in relation to the margin distance. RESULTS: Based on 10 studies, the meta-analysis showed that a tumour-free margin of <8 mm is associated with a higher risk of local recurrence compared to a tumour-free margin of ≥8 mm (pooled risk ratio, 1.99 [95% confidence interval {CI}: 1.13-3.51], p = 0.02). In the cohort study, we found no clear difference in the risk of local recurrence in the <8 versus ≥8 mm group; however, 40% of the patients in the <8 mm group received additional treatment. Tumour-positive margin was the only independent risk factor for local recurrence in the multivariable analysis (hazard ratio, 0.21 [95% CI: 0.08-0.55]). CONCLUSIONS: This work provides important data to question the commonly used 8-mm margin as a prognosticator for local recurrence. More research is needed to address the question of whether additional treatment improves the prognosis in patients with a tumour-free margin of <8 mm.
BACKGROUND: There is no consensus on the width of tumour-free margins after surgery for vulvar squamous cell carcinoma (VSCC). Most current guidelines recommend tumour-free margins of ≥8 mm. The aim of this study was to investigate whether a margin of <8 mm is associated with an increased risk of local recurrence in VSCC. METHODS: A meta-analysis of the available literature and a cohort study of 148 VSCC patients seen at a referral centre from 2000 to 2012 was performed. The primary end-point of the cohort study was a histologically confirmed ipsilateral local recurrence within 2 years after primary treatment in relation to the margin distance. RESULTS: Based on 10 studies, the meta-analysis showed that a tumour-free margin of <8 mm is associated with a higher risk of local recurrence compared to a tumour-free margin of ≥8 mm (pooled risk ratio, 1.99 [95% confidence interval {CI}: 1.13-3.51], p = 0.02). In the cohort study, we found no clear difference in the risk of local recurrence in the <8 versus ≥8 mm group; however, 40% of the patients in the <8 mm group received additional treatment. Tumour-positive margin was the only independent risk factor for local recurrence in the multivariable analysis (hazard ratio, 0.21 [95% CI: 0.08-0.55]). CONCLUSIONS: This work provides important data to question the commonly used 8-mm margin as a prognosticator for local recurrence. More research is needed to address the question of whether additional treatment improves the prognosis in patients with a tumour-free margin of <8 mm.
Authors: Jan Heidkamp; Petra L M Zusterzeel; Adriana C H van Engen-van Grunsven; Christiaan G Overduin; Andor Veltien; Arie Maat; Maroeska M Rovers; Jurgen J Fütterer Journal: NMR Biomed Date: 2018-11-15 Impact factor: 4.044
Authors: Kim E Kortekaas; Koen K Van de Vijver; Mariëtte I E van Poelgeest; C Blake Gilks; Vincent T H B M Smit; Saimah Arif; Deep Arora; Asma Faruqi; Raji Ganesan; Nicholas R Griffin; Richard Hale; Yelin E Hock; Lars-Christian Horn; W Glenn McCluggage; Pinias Mukonoweshuro; Kay J Park; Brian Rous; Bruce Tanchel; Anne-Sophie Van Rompuy; Gerry van Schalkwyk; Jo Vella; Marco Vergine; Naveena Singh; Tjalling Bosse Journal: Int J Gynecol Pathol Date: 2020-09 Impact factor: 3.326
Authors: Bertine W Huisman; Merve Cankat; Tjalling Bosse; Alexander L Vahrmeijer; Robert Rissmann; Jacobus Burggraaf; Cornelis F M Sier; Mariette I E van Poelgeest Journal: Cancers (Basel) Date: 2021-11-29 Impact factor: 6.639