Abstract
Background
To date, information on risk factors and temporal patterns of recurrences in patients with vulvar cancer is sparse. Conclusive data for an optimal surveillance strategy are lacking.
Methods
This multicenter, retrospective population-based register study included 1412 patients who have been treated from 2000 to 2017 for vulvar cancer in the German districts of Upper Palatinate, Lower Bavaria, and Saxony-Anhalt. Kaplan–Meier method, and univariate and multivariate Cox regression were employed to evaluate prognostic factors and temporal course of overall survival, cumulative recurrence, and recurrence-free survival rates.
Results
After exclusion, the final study cohort comprised 829 patients. Most recurrences occurred within the first 3 years after diagnosis. Notably, a significant subset of patients were recurrent even after 5 years. The cumulative recurrence rate from all relapses was 18.6% 1 year after primary diagnosis. The recurrence rate increased to 34.7% after 3, to 41.8% after 5, and to 56.6% after 10 years post-diagnosis. The risk of relapse was significantly increased in patients over 70 years of age (hazard ratio (HR) = 2.7; p < 0.001; 95% CI 1.6–4.4), and in patients with positive nodal status N1 (HR = 2.0; p = 0.019; 95% CI 1.1–3.5) and N2/3 (HR = 2.2; p = 0.033; 95% CI 1.1–4.4).
Conclusion
Our study provides compelling evidence that follow-up care should be carried out for longer than 5 years, especially for high-risk patients.
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References
Elit L, Reade CJ (2015) Recommendations for follow-up care for gynecologic cancer survivors. Obstet Gynecol 126:1207–1214. https://doi.org/10.1097/AOG.0000000000001129
Fonseca-Moutinho JA, Coelho MC, Silva DP (2000) Vulvar squamous cell carcinoma. Prognostic factors for local recurrence after primary en bloc radical vulvectomy and bilateral groin dissection. J Reprod Med 45:672–678 (PMID: 10986688)
Gillison ML, Chaturvedi AK, Lowy DR (2008) HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer 113:3036–3046. https://doi.org/10.1002/cncr.23764
Gonzalez Bosquet J, Magrina JF, Gaffey TA, Hernandez JL, Webb MJ, Cliby WA, Podratz KC (2005) Long-term survival and disease recurrence in patients with primary squamous cell carcinoma of the vulva. Gynecol Oncol 97:828–833. https://doi.org/10.1016/j.ygyno.2005.03.006
Koh W, Greer BE, Abu-Rustum NR, Campos SM, Cho KR, Chon HS, Chu C, Cohn D, Crispens MA, Dizon DS, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Higgins S, Huh WK, Lurain JR III, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Valea FA, Wyse E, Yashar CM, McMillian N, Scavone J (2017) Vulvar cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 15(1):92–120. https://doi.org/10.6004/jnccn.2017.0008
Raspagliesi F, Hanozet F, Ditto A, Solima E, Zanaboni F, Vecchione F, Kusamura S (2006) Clinical and pathological prognostic factors in squamous cell carcinoma of the vulva. Gynecol Oncol 102:333–337. https://doi.org/10.1016/j.ygyno.2005.12.027
Robert Koch Institut (2017) Krebs in Deutschland. https://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland. Accessed 5 Dec 2021
Salom EM, Penalver M (2002) Recurrent vulvar cancer. Curr Treat Options Oncol 3:143–153. https://doi.org/10.1007/s11864-002-0060-x
Schnürch HG, Ackermann S, Alt CD, Barinoff J, Böing C, Dannecker C, Gieseking F, Günthert A, Hantschmann P, Horn LC, Kürzl R, Mallmann P, Marnitz S, Mehlhorn G, Hack CC, Koch MC, Torsten U, Weikel W, Wölber L, Hampl M (2016) Diagnosis, therapy and follow-up care of vulvar cancer and its precursors. Guideline of the DGGG and DKG (S2k-Level, AWMF Registry Number 015/059, November 2015. Geburtshilfe Frauenheilkd 76(10):1035–1049. https://doi.org/10.1055/s-0042-103728 (PMID: 27765958; PMCID: PMC5066425)
Zapardiel I, Iacoponi S, Coronado PJ, Zalewski K, Chen F, Fotopoulou C, Dursun P, Kotsopoulos IC, Jach R, Buda A, Martinez-Serrano MJ, Grimm C, Fruscio R, Garcia E, Sznurkowski JJ, Ruiz C, Noya MC, Barazi D, Diez J, Diaz De la Noval B, Bartusevicius A, De Iaco P, Otero M, Diaz M, Haidopoulos D, Franco S, Blecharz P, Zuñiga MA, Rubio P, Gardella B, Papatheodorou DC, Yildirim Y, Fargas F, Macuks R, VULCAN Study coinvestigators (2020) Prognostic factors in patients with vulvar cancer: the VULCAN study. Int J Gynecol Cancer 30:1285–1291. https://doi.org/10.1136/ijgc-2019-000526
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Röhrmoser, K., Ignatov, A., Gerken, M. et al. Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration. J Cancer Res Clin Oncol 149, 803–810 (2023). https://doi.org/10.1007/s00432-022-03954-x
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DOI: https://doi.org/10.1007/s00432-022-03954-x