PROGNOSTIC FACTORS IN CARCINOMA OF THE VULVA - A CLINICOPATHOLOGICAL AND DNA FLOW CYTOMETRIC STUDY

The clinical staging of carcinoma of the vulva is a predictor of patie nt survival; however, the significance of other prognostic factors rem ains somewhat controversial. Length of survival after diagnosis of inv asive squamous cell carcinoma was determined for 39 clinically staged and surgically treated patients who were followed at our institution. Clinical stage, tumor type, use of radiotherapy (RT), histopathologic features (invasive pattern, depth of invasion, lymph node status, nucl ear grade, adjacent dysplasia, desmoplasia, inflammation) and DNA ploi dy (determined by flow cytometry from paraffin-embedded tissue) were e valuated as predictors of survival. Kaplan-Meier survival curves were generated for strata defined by each of the various predictors and com pared using the log-rank test. Advanced stage (p = 0.0002), RT use (p = 0.0004), ''spray'' invasive pattern (p = 0.005), positive lymph node status (p = 0.001), increased positive lymph node number (p = 0.016), and greater depth of invasion (p = 0.039) were associated univariantl y with decreased survival time. Spray invasive pattern (p = 0.018), po sitive lymph node status (p = 0.030), positive lymph node number (p = 0.040), and RT use (p = 0.045) continued to be associated with decreas ed survival time after controlling for stage. Of the significant facto rs, invasive pattern stands out as a qualitative feature that may have potential benefit in predicting survival independent of clinical stag e in patients with vulvar carcinoma.