STAGING AND RECURRENCE OF DISEASE IN SQUAMOUS-CELL CARCINOMA OF THE VULVA

In order to determine the prognostic significance of applying the revi sed FIGO staging system and identify factors contributing to survival after documentation of recurrent disease, a retrospective chart review of our vulvar cancer population was performed. Over a 17-year interva l 135 patients were uniformly treated with primary surgical treatment consisting of radical vulvectomy and bilateral groin dissection. Facto rs contributing to disease-free survival were analyzed using a Cox pro portional hazards model. Covariates of survival after recurrence of di sease were analyzed using the log-rank method. Neither the clinical as sessment of the groin nodes, nor the presence or absence of perineal i nvolvement were related to outcome. Only lesion size and surgical stat us of the inguinal nodes were significant predictors of disease-free s urvival (P = 0.02 and P = 0.03, respectively). In addition, there was a statistically significant relationship between the extent of groin i nvolvement (negative, unilateral positive, and bilateral positive node s) and associated decrement in disease-free survival (P = 0.01). Thirt y patients developed recurrence of disease from 2.0 to 47.3 months fol lowing surgery. The location of the recurrence, interval from primary therapy to recurrence, and status of the groin nodes at initial surger y were significant prognostic factors in subsequent survival. The revi sed staging system demonstrated an improvement in patient stratificati on compared to the criteria of the prior classification. The data are also consistent with the distinction made between Stage III and TV dis ease in the new classification. The status of the groin nodes at origi nal surgery remained an important prognostic factor even in those pati ents who later demonstrated recurrence of disease. (C) 1995 Academic P ress, Inc.