DISEASE-FREE SURVIVAL IN PATIENTS WITH SQUAMOUS-CELL CARCINOMA OF THEVULVA TREATED WITH RADICAL VULVECTOMY AND BILATERAL INGUINAL-FEMORAL LYMPHADENECTOMY - ANALYSIS OF PROGNOSTIC VARIABLES

Background and methods - The present retrospective investigation was u ndertaken to evaluate the importance of some prognostic variables on t he disease- free survival of 38 patients with squamous cell carcinoma of the vulva treated with radical vulvectomy and bilateral inguinal-fe moral lymphadenectomy, and to draw conclusions about new treatment app roaches which could improve patient outcome. Results - On univariate a nalysis, disease-free survival was significantly related to tumor size (>3 cm versus less-than-or-equal-to 3 cm, p = 0.0046), T stage (T3 ve rsus T1-T2, p = 0.0083), and lymph node status (positive versus negati ve, p = 0.0078), but not to tumor site, histological grade and age. As for patients with nodal metastases, disease-free survival was signifi cantly related to the number of positive lymph nodes (greater-than-or- equal-to 3 versus <3 ). At multivariate analysis, T stage and lymph no de status were the only independent prognostic factors. Conclusions - Surgery represents the keystone in the management of squamous cell car cinoma of the vulva. No adjuvant treatment is needed for patients with T1-T2 stage disease and with histologically negative lymph nodes or w ith one or two positive lymph nodes. Conversely, patients with T3 stag e disease or with three or more positive lymph nodes display a high re currence rate after radical surgery alone. Integrated treatment protoc ols, including radiotherapy or chemo-radiotherapy, need to be explored for these high-risk patients.