Survival and prognosis factors of lymphadenectomy in vulvar carcinoma: A tunisian single center study about 150 cases

Abstract

Objective: Lymph node metastases represent the major prognostic factor in squamous cell carcinoma of the vulva. However, the therapeutic value is still controversial. The purpose of our work was to identify histopronostic risk factors for lymph node involvement and assess the impact of lymphadenectomy on overall survival (OS) and recurrence free survival (RFS). Method: This was a retrospective study about 150 cases of squamous cell carcinoma of the vulva over a period of 21 years (1994–2014). Clinical, anatomaphatological and evolutionary data were reported. OS and RFS curves for different parameters were established. Results: Lymph node invasion was significantly correlated with age 2 cm, TNM T-stage, vascular emboli and perinerval invasion. 5-years OS and RFS was 50.3% and 63.8% respectively. The 5-year OS and RFS rate decreased from 61.8% and 81.8% in the absence of lymph node involvement to 31.3% and 70.7% in cases of lymph node involvement respectively. The OS and the RFS at 5 years went from 53.1% and 63.8% to 18.2% and 42.7% respectively, in case of capsular break-up. Bilateral lymph node involvement caused the decrease of the 5-years OS from 52.5% to 34.1%. The lymph node ratio was inversely proportional to the OS. 5-years OS was 39% in case of a ratio <10% and 13% for a ratio between 20% and 30%. The 5-year RFS, decreased from 46% for a ratio <10%, to 24% for a ratio between 20% and 30%. Superficial inguinal lymph node dissection exposed to a high risk of inguinal recurrence. Conclusion: The lymphadenectomy has an incontestable diagnostic and prognostic value. The aim is to optimize the groin management in order to limit the morbidity of lymph node dissection while guaranteeing a carcinological safety. Keywords: Vulvar tumor, Squamous cell carcinoma, Surgery, Lymph node excision, Survival