Sentinel nodes in vulvar cancer: Long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I

• Ten year disease-specific survival is 91% for patients with a negative sentinel node.
• Local recurrence rate at ten year after primary treatment is 39.5% for all patients.
• Disease-specific survival decreases significantly in case a local recurrence occurs.

ObjectiveIn 2008 GROINSS-V-I, the largest validation trial on the sentinel node (SN) procedure in vulvar cancer, showed that application of the SN-procedure in patients with early-stage vulvar cancer is safe. The current study aimed to evaluate long-term follow-up of these patients regarding recurrences and survival.MethodsFrom 2000 until 2006 GROINSS-V-I included 377 patients with unifocal squamous cell carcinoma of the vulva (T1,<4 cm), who underwent the SN-procedure. Only in case of SN metastases an inguinofemoral lymphadenectomy was performed. For the present study follow-up was completed until March 2015.ResultsThe median follow-up was 105 months (range 0–179). The overall local recurrence rate was 27.2% at 5 years and 39.5% at 10 years after primary treatment, while for SN-negative patients 24.6% and 36.4%, and for SN-positive patients 33.2% and 46.4% respectively (p = 0.03). In 39/253 SN-negative patients (15.4%) an inguinofemoral lymphadenectomy was performed, because of a local recurrence. Isolated groin recurrence rate was 2.5% for SN-negative patients and 8.0% for SN-positive patients at 5 years. Disease-specific 10-year survival was 91% for SN-negative patients compared to 65% for SN-positive patients (p < .0001). For all patients, 10-year disease-specific survival decreased from 90% for patients without to 69% for patients with a local recurrence (p < .0001).ConclusionsSurvival is very good for patients with a negative SN, but still 36% of these patients, as well as 46% of the patients with a positive SN, will have a local recurrence. Although a local recurrence is treated with curative intent, the disease-specific survival of these patients decreases significantly.