Patterns of recurrence in patients with squamous cell carcinoma of the vulva - A multicenter CTF study

BACKGROUND, Invasive vulvar carcinoma is a rare disease with an incidence r ate of 3-5% of all female genital neoplasms. The current study discusses th e limited number of articles in the literature regarding the patterns of re currence as well as the clinical outcome of patients with recurrent disease based on a consistent and consecutive series of cases. METHODS. A common clinical chart focusing on the study of patterns of recur rence was used in five Italian gynecologic institutions with uniform criter ia of surgical nomenclature, pathologic variables, and sites of recurrence. Between 1980-1994, 502 cases of primary invasive squamous carcinoma of the vulva were registered consecutively, treated, and considered for this mult icentered study. RESULTS. of 502 patients, 187 (37.3%) developed a recurrence. Distribution of the recurrences by site was as follows: perineal, 53.4%; inguinal, 18.7% ; pelvic, 5.7%; distant, 7.9%; and multiple, 14.2%. In a multivariate analy sis, 3 characteristics appeared to be statistically correlated with the ris k of recurrence: International Federation of Gynecology and Obstetrics Stag e > II (P = 0.029), positive lymph nodes (P = 0.009), and vascular space in vasion (P = 0.004). The 5-year survival rate was 60% for perineal recurrenc es, 27% for inguinal and pelvic recurrences, 15% for distant recurrences, a nd 14% for multiple recurrences. CONCLUSIONS. In the current study the prognostic factors found to have stat istical significance as prognostic factors for risk of recurrence were tumo r dimension, lymph node involvement, and stromal and vascular space invasio n. The presence of inguinal lymph. node metastases was predictive of multip le and distant recurrences with a low rate of incidence of isolated perinea l recurrence (27%) compared with negative lymph node cases (57.5%). Surviva l analysis of recurrent disease showed that the surgical resection of local recurrences may provide acceptable results (51% at 5 years). This observat ion may justify a follow-up program aimed at identifying those patients wit h early local recurrence suitable for radical resection.