A low-risk group suitable for conservative surgery exists in patients with vulvar cancer.
Control Arm(s):
NA
Experimental Arm(s):
NA
Primary End Point:
Histologically positive groin nodes
Inclusion Criteria:
Prospecitive group of vulvar cancer patients who were treated by radical vulvectomy and bilateral groin node dissection from 1977 to 1984 whose tumor size was noted to be superficial, = 5mm.
Exclusion Criteria:
Tumor size > 5mm
Results:
272 women with tumor = 5mm
- 57 (21%) had positive groin lymph nodes
The proportion of patients with positive nodes rose steadily with each millimeter of thickness from:
- 3.1% if =1mm
- 8.9% if 2mm
- 18.6% if 3mm
- 30.9 if 4mm
- 33.3% if 5mm
Only 5 variables showed a statistically significant correlation with groin node metastasis: Clinical node status, tumor thickness, capillary-like space involvement, histologic tumor grade (Grade 1-4), and perineal or clitoral location.
These variables were used in a multivariate logistic model to predict node metastasis.
Conclusions:
The lowest risk for lymph node metastases (0 observed, 2% expected) is a subset of patients with no clinically suspicious nodes, no LVSI, non-midline tumors that were either grade 1 (1-5mm thick) or grade 2 (1-2mm thick).