Linn Woelber1, Christine Eulenburg2, Jens Kosse3, Petra Neuser4, Christoph Heiss5, Peer Hantschmann6, Peter Mallmann7, Berno Tanner8, Jacobus Pfisterer9, Julia Jückstock10, Felix Hilpert11, Nikolaus de Gregorio12, Severine Iborra13, Jalid Sehouli14, Atanas Ignatov15, Peter Hillemanns16, Sophie Fürst10, Hans-Georg Strauss17, Sven Mahner18, Katharina Prieske19. 1. Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: lwoelber@uke.de. 2. Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany. 3. Department of Gynecology, Sana Klinikum Offenbach, Offenbach, Germany. 4. KKS Philipps University Marburg, Marburg, Germany. 5. Department of Obstetrics and Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany. 6. Kreisklinik Altoetting, Altoettingen, Germany. 7. Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany. 8. Private Practice for Obstetrics and Gynecology, Hohen Neuendorf, Germany. 9. Gynecologic Oncology Center, Kiel, Germany. 10. Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany. 11. Department of Gynecology and Gynecologic Oncology, Universtiy Hospital Kiel, Kiel, Germany; Breast Center at the Jerusalem Hospital Hamburg, Hamburg, Germany. 12. Department of Gynecology and Obstetrics, University Hospital Ulm, Germany. 13. Department of Gynecology and Obstetrics, University Hospital Freiburg, Freiburg, Germany; Department of Gynecology and Obstetrics, University Hospital Aachen, Germany. 14. Department of Gynecology and Gynecologic Oncology, Charité Campus Virchow, Berlin, Germany. 15. Department of Gynecology and Gynecologic Oncology, University Hospital Magdeburg, Magdeburg, Germany. 16. Department of Obstetrics and Gynecology, Medical University Hannover, Hannover, Germany. 17. Department of Obstetrics and Gynecology, University of Halle, Halle (Saale), Germany. 18. Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany. 19. Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
OBJECTIVE: In vulvar cancer (VSCC), the course of disease with regard to localization of recurrence and relation of different recurrence sites is poorly described. METHODS: The AGO CaRE-1 study is a retrospective survey of treatment patterns and prognostic factors in vulvar cancer. Patients (pts) with primary VSCC, FIGO stage ≥1B treated in Germany from 1998 to 2008 were included in a centralized database (n = 1618). In the current subgroup analysis, different sites of primary recurrence and their impact on disease course and survival were analyzed using multistate and competing risks methods. RESULTS: 1249 pts with surgical groin staging and known lymph-node status (35.8% N+) were included in the analysis. 360 pts (28.8%) developed disease recurrence; thereof 193 (53.6%) at the vulva only, with a cumulative incidence of 12.6% after 2 years. Generally, prognosis after disease depended on recurrence site: Hazard ratios (HRs) (95% confidence interval) to die for pts with compared to without recurrence at the same time: vulvar only: 5.9 (4.3-8.2); groins only: 6.0 (3.0-10.2); vulvar and groins: 14.1 (7.6-26.4); pelvic/distant: 21.2 (15.3-29.4). Fifty-eight (30.1%) pts with local recurrence developed second recurrence. 2-year mortality after any recurrence was 56.3%. After vulvar recurrence pts had a 2-year and 5-year overall survival rate of 82.2% and 66.9%. CONCLUSIONS: Prognosis after recurrence is highly depending on recurrence site. Pts with isolated vulvar recurrence have an impaired prognosis as many affected pts develop second recurrences.
OBJECTIVE: In vulvar cancer (VSCC), the course of disease with regard to localization of recurrence and relation of different recurrence sites is poorly described. METHODS: The AGO CaRE-1 study is a retrospective survey of treatment patterns and prognostic factors in vulvar cancer. Patients (pts) with primary VSCC, FIGO stage ≥1B treated in Germany from 1998 to 2008 were included in a centralized database (n = 1618). In the current subgroup analysis, different sites of primary recurrence and their impact on disease course and survival were analyzed using multistate and competing risks methods. RESULTS: 1249 pts with surgical groin staging and known lymph-node status (35.8% N+) were included in the analysis. 360 pts (28.8%) developed disease recurrence; thereof 193 (53.6%) at the vulva only, with a cumulative incidence of 12.6% after 2 years. Generally, prognosis after disease depended on recurrence site: Hazard ratios (HRs) (95% confidence interval) to die for pts with compared to without recurrence at the same time: vulvar only: 5.9 (4.3-8.2); groins only: 6.0 (3.0-10.2); vulvar and groins: 14.1 (7.6-26.4); pelvic/distant: 21.2 (15.3-29.4). Fifty-eight (30.1%) pts with local recurrence developed second recurrence. 2-year mortality after any recurrence was 56.3%. After vulvar recurrence pts had a 2-year and 5-year overall survival rate of 82.2% and 66.9%. CONCLUSIONS: Prognosis after recurrence is highly depending on recurrence site. Pts with isolated vulvar recurrence have an impaired prognosis as many affected pts develop second recurrences.