A MULTIVARIATE-ANALYSIS OF CLINICAL AND MORPHOLOGICAL PROGNOSTIC FACTORS IN SQUAMOUS-CELL CARCINOMA OF THE VULVA

Clinical and histological data of 168 patients with squamous cell carc inoma of the vulva were analyzed with respect to survival. 151 patient s underwent surgery, 12 patients were treated with primary radiation a nd in 5 patients no treatment was performed. Follow-up lasted from at least 2 up to 22 years' posttreatment. In univariate analysis, the fol lowing factors were highly significant: presurgery lymph node status, tumor infiltration beyond the vulva, tumor grading, histological ingui nal lymph node status, pre- and postsurgery tumor stage, depth of inva sion and tumor diameter. In the multivariate analysis (Cox regression) , the most powerful factors were shown to be histological inguinal lym ph node status, tumor diameter and tumor grading. The multivariate log istic regression analysis worked out as main prognostic factors for me tastases of inguinal lymph nodes: presurgery inguinal lymph node statu s, tumor size, depth of invasion and tumor grading. Based on these res ults, tumor biology seems to be the decisive factor concerning recurre nce and survival. Therefore, we suggest a more conservative treatment of vulvar carcinoma. Patients with confined carcinoma to the vulva, wi th a tumor diameter up to 3 cm and without clinical suspected lymph no des, should be treated by wide excision/partial vulvectomy with ipsila teral lymphadenectomy.