Linn Woelber1, Lis-Femke Griebel2, Christine Eulenburg3, Jalid Sehouli4, Julia Jueckstock5, Felix Hilpert6, Nikolaus de Gregorio7, Annette Hasenburg8, Atanas Ignatov9, Peter Hillemanns10, Sophie Fuerst11, Hans-Georg Strauss12, Klaus H Baumann13, Falk C Thiel14, Alexander Mustea15, Werner Meier16, Philipp Harter17, Pauline Wimberger18, Lars Christian Hanker19, Barbara Schmalfeldt20, Ulrich Canzler18, Tanja Fehm21, Alexander Luyten22, Martin Hellriegel23, Jens Kosse24, Christoph Heiss25, Peer Hantschmann26, Peter Mallmann27, Berno Tanner28, Jacobus Pfisterer29, Barbara Richter30, Petra Neuser31, Sven Mahner32. 1. Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: lwoelber@uke.de. 2. Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department for Epidemiology, Medical Statistics and Decision Making, University Medical Center Groningen, Groningen, The Netherlands. 4. Department of Gynecology, Charité, University Medicine Berlin, Berlin, Germany. 5. Department of Gynecology and Obstetrics, University of Munich, Munich, Germany. 6. University Medical Center Kiel, Kiel, Germany; Jerusalem Hospital, Hamburg, Germany. 7. Department of Gynecology, University of Ulm, Ulm, Germany. 8. Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Gynecology and Obstetrics, University Hospital Mainz, Mainz, Germany. 9. Department of Gynecology, University of Magdeburg, Magdeburg, Germany. 10. Department of Gynecology, Hannover Medical School, Hannover, Germany. 11. Department of Gynecology, University of Munich (LMU), Munich, Germany. 12. Department of Gynecology, University of Halle, Halle, Germany. 13. Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany; Department of Gynecology, Klinikum Ludwigshafen, Ludwigshafen, Germany. 14. Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany; Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany. 15. Department of Gynecology, University Medicine Greifswald, Greifswald, Germany. 16. Department of Gynecology, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany. 17. Department of Gynecology, Kliniken Essen Mitte, Essen, Germany. 18. Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany. 19. Department of Gynecology, University Hospital Frankfurt, Frankfurt, Germany; Department of Gynecology, UKSH Campus Lübeck, Lübeck, Germany. 20. Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology, University Hospital Technical University of Munich, Germany. 21. Department of Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany; Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany. 22. Department of Gynecology, Obstetrics and Gynecologic Oncology, Wolfsburg Hospital, Wolfsburg, Germany. 23. Department of Gynecology, Georg-August-University Goettingen, Goettingen, Germany. 24. Department of Gynecology, Offenbach Hospital, Offenbach, Germany. 25. Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany. 26. Department of Gynecology, Hospital Altoettingen, Altoettignen, Germany. 27. Department of Gynecology, University Hospital Cologne, Cologne, Germany. 28. Oberhavel Hospital, Oranienburg, Germany. 29. Gynecologic Oncology Center, Kiel, Germany. 30. Elbland Hospital Meißen-Radebeul, Radebeul Germany. 31. KKS Philipps University Marburg, Marburg; Germany. 32. Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology and Obstetrics, University of Munich, Munich, Germany; Department of Gynecology, University of Munich (LMU), Munich, Germany.
Abstract
AIM OF THE STUDY: A tumour-free pathological resection margin of ≥8 mm is considered state-of-the-art. Available evidence is based on heterogeneous cohorts. This study was designed to clarify the relevance of the resection margin for loco-regional control in vulvar cancer. METHODS: AGO-CaRE-1 is a large retrospective study. Patients (n = 1618) with vulvar cancer ≥ FIGO stage IB treated at 29 German gynecologic-cancer-centres 1998-2008 were included. This subgroup analysis focuses on solely surgically treated node-negative patients with complete tumour resection (n = 289). RESULTS: Of the 289 analysed patients, 141 (48.8%) had pT1b, 140 (48.4%) pT2 and 8 (2.8%) pT3 tumours. One hundred twenty-five (43.3%) underwent complete vulvectomy, 127 (43.9%) partial vulvectomy and 37 (12.8%) radical local excision. The median minimal resection margin was 5 mm (1 mm-33 mm); all patients received groin staging, in 86.5% with full dissection. Median follow-up was 35.1 months. 46 (15.9%) patients developed recurrence, thereof 34 (11.8%) at the vulva, after a median of 18.3 months. Vulvar recurrence rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin ≥8 mm. When analysed as a continuous variable, the margin distance had no statistically significant impact on local recurrence (HR per mm increase: 0.930, 95% CI: 0.849-1.020; p = 0.125). Multivariate analyses did also not reveal a significant association between the margin and local recurrence neither when analysed as continuous variable nor categorically based on the 8 mm cutoff. Results were consistent when looking at disease-free-survival and time-to-recurrence at any site (HR per mm increase: 0.949, 95% CI: 0.864-1.041; p = 0.267). CONCLUSIONS: The need for a minimal margin of 8 mm could not be confirmed in the large and homogeneous node-negative cohort of the AGO-CaRE database. Copyright Â
AIM OF THE STUDY: A tumour-free pathological resection margin of ≥8 mm is considered state-of-the-art. Available evidence is based on heterogeneous cohorts. This study was designed to clarify the relevance of the resection margin for loco-regional control in vulvar cancer. METHODS: AGO-CaRE-1 is a large retrospective study. Patients (n = 1618) with vulvar cancer ≥ FIGO stage IB treated at 29 German gynecologic-cancer-centres 1998-2008 were included. This subgroup analysis focuses on solely surgically treated node-negative patients with complete tumour resection (n = 289). RESULTS: Of the 289 analysed patients, 141 (48.8%) had pT1b, 140 (48.4%) pT2 and 8 (2.8%) pT3 tumours. One hundred twenty-five (43.3%) underwent complete vulvectomy, 127 (43.9%) partial vulvectomy and 37 (12.8%) radical local excision. The median minimal resection margin was 5 mm (1 mm-33 mm); all patients received groin staging, in 86.5% with full dissection. Median follow-up was 35.1 months. 46 (15.9%) patients developed recurrence, thereof 34 (11.8%) at the vulva, after a median of 18.3 months. Vulvar recurrence rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin ≥8 mm. When analysed as a continuous variable, the margin distance had no statistically significant impact on local recurrence (HR per mm increase: 0.930, 95% CI: 0.849-1.020; p = 0.125). Multivariate analyses did also not reveal a significant association between the margin and local recurrence neither when analysed as continuous variable nor categorically based on the 8 mm cutoff. Results were consistent when looking at disease-free-survival and time-to-recurrence at any site (HR per mm increase: 0.949, 95% CI: 0.864-1.041; p = 0.267). CONCLUSIONS: The need for a minimal margin of 8 mm could not be confirmed in the large and homogeneous node-negative cohort of the AGO-CaRE database. Copyright Â
Authors: Sebastian Zięba; Anne-Floor W Pouwer; Artur Kowalik; Kamil Zalewski; Natalia Rusetska; Elwira Bakuła-Zalewska; Janusz Kopczyński; Johanna M A Pijnenborg; Joanne A de Hullu; Magdalena Kowalewska Journal: Int J Mol Sci Date: 2020-07-10 Impact factor: 5.923
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: Pavol Zubor; Yun Wang; Alena Liskova; Marek Samec; Lenka Koklesova; Zuzana Dankova; Anne Dørum; Karol Kajo; Dana Dvorska; Vincent Lucansky; Bibiana Malicherova; Ivana Kasubova; Jan Bujnak; Milos Mlyncek; Carlos Alberto Dussan; Peter Kubatka; Dietrich Büsselberg; Olga Golubnitschaja Journal: Int J Mol Sci Date: 2020-10-27 Impact factor: 5.923