Rüdiger Klapdor1, Linn Wölber2, Lars Hanker3, Barbara Schmalfeldt2, Ulrich Canzler4, Tanja Fehm5, Alexander Luyten6, Martin Hellriegel7, Jens Kosse8, Christoph Heiss9, Peer Hantschmann10, Peter Mallmann11, Berno Tanner12, Jacobus Pfisterer13, Julia Jückstock14, Felix Hilpert15, Nikolaus de Gregorio16, Peter Hillemanns17, Sophie Teresa Fürst14, Sven Mahner14. 1. Department of Gynecology, Hannover Medical School, Hannover, Germany. Electronic address: Klapdor.ruediger@mh-hannover.de. 2. Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Gynecology, UKSH Campus Lübeck, Lübeck, Germany. 4. Department of Gynecology and Obstetrics, Carl-Gustav-Carus University Dresden, TU Dresden, Dresden, Germany. 5. Department of Gynecology, Duesseldorf University Hospital, Duesseldorf, Germany; Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany. 6. Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany. 7. Department of Gynecology and Obstetrics, Georg-August-University, Göttingen, Germany. 8. Department of Gynaecology, Sana Klinikum Offenbach, Offenbach, Germany. 9. Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Göppingen, Germany. 10. Department of Gynecology, Hospital Altoettingen, Altoettignen, Germany. 11. Department of Gynecology, University Hospital Cologne, Cologne, Germany. 12. Oberhavel Hospital, Oranienburg, Germany. 13. Gynecologic Oncology Center, Kiel, Germany. 14. Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany. 15. Jerusalem Hospital, Hamburg, Germany. 16. Department of Gynecology, University of Ulm, Ulm, Germany. 17. Department of Gynecology, Hannover Medical School, Hannover, Germany.
Abstract
BACKGROUND: Lymph node (LN) metastasis is the most important prognostic factor in primary vulvar cancer. Assessing risk factors for the incidence and extent of LN metastases may help to select the optimal treatment strategy for each individual patient. METHODS: In a subgroup analysis of the large multicenter AGO-CaRE-1 study we included all patients treated with radical groin dissection. Univariate and multivariate regression analyses were performed in order to detect factors associated with the prevalence and extent of nodal involvement. RESULTS: In total, 1162 patients were analyzed. Univariate analyses detected age, ECOG as well as multiple tumor characteristics such as FIGO stage, grading, depth of invasion, tumor diameter, and (lymph)vascular space invasion to be related with the prevalence of LN metastases. Interestingly, only tumor stage, tumor diameter and depth of infiltration were found to be significantly associated with the number of LN metastases. In multivariate analysis, age (OR 1.03), lymphvascular space invasion (OR 4.97), tumor stage (OR 2.22) and depth of infiltration (OR 1.08) showed an association with the prevalence of LN metastases. Regarding the number of metastatic LNs, only tumor stage (OR 2.21) or, if excluded, tumor diameter (OR 1.02) were tested significant. CONCLUSION: This large analysis of the multicenter AGO-CaRE-1-study identified lymphvascular space invasion, tumor stage, and depth of infiltration as factors with the strongest association regarding the prevalence of LN metastasis. Interestingly, tumor stage or, if excluded, tumor diameter were the only factors associated with the prevalence as well as the extent of LN metastases.
BACKGROUND: Lymph node (LN) metastasis is the most important prognostic factor in primary vulvar cancer. Assessing risk factors for the incidence and extent of LN metastases may help to select the optimal treatment strategy for each individual patient. METHODS: In a subgroup analysis of the large multicenter AGO-CaRE-1 study we included all patients treated with radical groin dissection. Univariate and multivariate regression analyses were performed in order to detect factors associated with the prevalence and extent of nodal involvement. RESULTS: In total, 1162 patients were analyzed. Univariate analyses detected age, ECOG as well as multiple tumor characteristics such as FIGO stage, grading, depth of invasion, tumor diameter, and (lymph)vascular space invasion to be related with the prevalence of LN metastases. Interestingly, only tumor stage, tumor diameter and depth of infiltration were found to be significantly associated with the number of LN metastases. In multivariate analysis, age (OR 1.03), lymphvascular space invasion (OR 4.97), tumor stage (OR 2.22) and depth of infiltration (OR 1.08) showed an association with the prevalence of LN metastases. Regarding the number of metastatic LNs, only tumor stage (OR 2.21) or, if excluded, tumor diameter (OR 1.02) were tested significant. CONCLUSION: This large analysis of the multicenter AGO-CaRE-1-study identified lymphvascular space invasion, tumor stage, and depth of infiltration as factors with the strongest association regarding the prevalence of LN metastasis. Interestingly, tumor stage or, if excluded, tumor diameter were the only factors associated with the prevalence as well as the extent of LN metastases.
Authors: Marlene Röttger; Hermann Hertel; Laura Kaukemüller; Lars Brodowski; Markus Flentje; Peter Hillemanns; Rüdiger Klapdor Journal: Arch Gynecol Obstet Date: 2020-07-18 Impact factor: 2.344
Authors: Andreas Suhartoyo Winarno; Anne Mondal; Franca Christina Martignoni; Tanja Natascha Fehm; Monika Hampl Journal: BMC Womens Health Date: 2021-01-12 Impact factor: 2.809