Stephan Polterauer1, Richard Schwameis2, Christoph Grimm2, Peter Hillemanns3, Julia Jückstock4, Felix Hilpert5, Nikolaus de Gregorio6, Annette Hasenburg7, Jalid Sehouli8, Sophie Theresa Fürst3, Hans Georg Strauß9, Klaus Baumann10, Falk Thiel11, Alexander Mustea12, Philipp Harter13, Pauline Wimberger14, Heinz Kölbl2, Alexander Reinthaller15, Linn Woelber16, Sven Mahner17. 1. Department of Obstetrics and Gynecology, Division General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria; Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Austria. Electronic address: Stephan.polterauer@meduniwien.ac.at. 2. Department of Obstetrics and Gynecology, Division General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria. 3. Department of Obstetrics and Gynecology, Medical University Hannover, Germany. 4. Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany. 5. Onkologisches Therapiezentrum am Krankenhaus Jerusalem, Hamburg, Germany. 6. Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany. 7. Department of Gynecology, Johannes Gutenberg University Medical Center, Mainz, Germany; Department of Obstetrics and Gynecology, University Hospital Freiburg, Germany. 8. Department of Gynecology, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Germany. 9. Department of Gynecology, University of Halle, Halle, Germany; Department of Gynecology, Klinikum Ludwigshafen, Ludwigshafen, Germany. 10. Department of Gynecology, Obstetris University Hospital Marburg, Marburg, Germany. 11. Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Department of Gynecology, University Hospital Erlangen, Germany. 12. Department of Gynecology, University Medicine of Greifswald, Greifswald, Germany. 13. Department of Gynecology, Kliniken Essen Mitte, Essen, Germany. 14. Department of Gynecology and Obstetrics, Technische Universität Dresden, TU Dresden, Dresden, Department of Gynecology and Obstretrics, University Hospital Essen, Germany. 15. Department of Obstetrics and Gynecology, Division General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria; Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Austria. 16. Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany. 17. Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany; Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
Abstract
OBJECTIVE: Lymph node ratio (LNR) can predict treatment outcome and prognosis in patients with solid tumors. Aim of the present analysis was to confirm the concept of using LNR for assessing outcome in patients with vulvar cancer after surgery with inguinal lymphadenectomy in a large multicenter project. METHODS: The AGO-CaRE-1 study multicenter database was used for analysis. LNR was defined as ratio of number of positive lymph nodes (LN) to the number of resected. Previously established LNR risk groups were used to stratify patients. LNR was investigated with respect to clinical parameters. Univariate and multivariable survival analyses were performed to assess the value of LNR in order to predict overall (OS) and progression-free (PFS) survival. RESULTS: In total, 1047 patients treated with surgery including inguinal lymph node resection for squamous cell carcinoma of the vulva were identified from the database. Of these, 370 (35.3%) were found to have positive inguinal LN. In total, 677 (64.7%) had a LNR of 0% (N0), 255 (24.4%) a LNR of >0% < 20%, and 115 (11%) a LNR of ≥20%. Patients with higher LNR were found to have larger tumor size (P < .001), advanced tumor stage (P < .001), high tumor grade (P < .001), and deep stromal invasion (P < .001), more frequently. Three-year PFS rates were 75.7%, 44.2%, and 23.1% and three-year OS rates were 89.7%, 65.4%, and 41.9%, in patients with LNRs 0%, >0% < 20%, and ≥20%, respectively (P < .001, P < .001). On multivariable analyses LNR (HR 7.75, 95%-CI 4.01-14.98, P < .001), FIGO stage (HR 1.41, 95%-CI 1.18-1.69, P < .001), and patient's performance status (HR 1.59, 95%-CI 1.39-1.82, P < .001), were associated with PFS. In addition, LNR (HR 12.74, 95%-CI 5.64-28.78, P < .001), and performance status (HR 1.72, 95%-CI 1.44-2.07, P < .001) were also the only two parameters independently associated with OS. LNR generally showed stronger correlation than number of affected LN when comparing the two different multivariable models. CONCLUSIONS: In women with vulvar cancer LNR appears to be a consistent, independent prognostic parameter for both PFS and OS and allows patient stratification into three distinct risk groups. In survival analyses, LNR outperformed nodal status and number of positive nodes.
OBJECTIVE: Lymph node ratio (LNR) can predict treatment outcome and prognosis in patients with solid tumors. Aim of the present analysis was to confirm the concept of using LNR for assessing outcome in patients with vulvar cancer after surgery with inguinal lymphadenectomy in a large multicenter project. METHODS: The AGO-CaRE-1 study multicenter database was used for analysis. LNR was defined as ratio of number of positive lymph nodes (LN) to the number of resected. Previously established LNR risk groups were used to stratify patients. LNR was investigated with respect to clinical parameters. Univariate and multivariable survival analyses were performed to assess the value of LNR in order to predict overall (OS) and progression-free (PFS) survival. RESULTS: In total, 1047 patients treated with surgery including inguinal lymph node resection for squamous cell carcinoma of the vulva were identified from the database. Of these, 370 (35.3%) were found to have positive inguinal LN. In total, 677 (64.7%) had a LNR of 0% (N0), 255 (24.4%) a LNR of >0% < 20%, and 115 (11%) a LNR of ≥20%. Patients with higher LNR were found to have larger tumor size (P < .001), advanced tumor stage (P < .001), high tumor grade (P < .001), and deep stromal invasion (P < .001), more frequently. Three-year PFS rates were 75.7%, 44.2%, and 23.1% and three-year OS rates were 89.7%, 65.4%, and 41.9%, in patients with LNRs 0%, >0% < 20%, and ≥20%, respectively (P < .001, P < .001). On multivariable analyses LNR (HR 7.75, 95%-CI 4.01-14.98, P < .001), FIGO stage (HR 1.41, 95%-CI 1.18-1.69, P < .001), and patient's performance status (HR 1.59, 95%-CI 1.39-1.82, P < .001), were associated with PFS. In addition, LNR (HR 12.74, 95%-CI 5.64-28.78, P < .001), and performance status (HR 1.72, 95%-CI 1.44-2.07, P < .001) were also the only two parameters independently associated with OS. LNR generally showed stronger correlation than number of affected LN when comparing the two different multivariable models. CONCLUSIONS: In women with vulvar cancer LNR appears to be a consistent, independent prognostic parameter for both PFS and OS and allows patient stratification into three distinct risk groups. In survival analyses, LNR outperformed nodal status and number of positive nodes.
Authors: Angiolo Gadducci; Sabina Pistolesi; Stefania Cosio; Chiara Comunale; Antonio Fanucchi; Antonio Giuseppe Naccarato Journal: In Vivo Date: 2021 Mar-Apr Impact factor: 2.155
Authors: David J Nusbaum; Rachel S Mandelbaum; Hiroko Machida; Shinya Matsuzaki; Lynda D Roman; Anil K Sood; David M Gershenson; Koji Matsuo Journal: Arch Gynecol Obstet Date: 2020-04-17 Impact factor: 2.344