Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: A multivariate analysis

Objectives.To determine the importance of margin status and other prognostic factors associated with the recurrence and survival of patients with squamous cell vulvar carcinoma.Methods.Data were analyzed using Kaplan–Meier methods and Cox proportional hazards regression. All slides were re-reviewed by two gynecologic pathologists.Results.Ninety patients (median age: 69) were treated for vulvar carcinoma from 1984 to 2002, including 28 FIGO stage I, 20 stage II, 26 stage III and 16 with stage IV disease. Sixty-three (70%) patients underwent complete radical vulvectomies and 27 (30%) had modified radical vulvectomies. Nineteen (20%) patients received adjuvant radiotherapy. Five-year disease-specific survival rates were 100%, 100%, 86% and 29% for stages I–IV, respectively. None of the 30 patients with a pathologic margin distance > 8 mm had local recurrence. Of the 53 women with tumor-free pathologic margin of < 8 mm, 12 (23%) had a local recurrence. Moreover, women with > 2 positive groin nodes had significantly higher recurrence risk compared to those with < 2 metastatic groin nodes (p < 0.001). On multivariate analysis, positive groin nodes and margin distance were important prognostic factors for recurrence. Moreover, stage, tumor size, margin distance, and depth of invasion were significant independent predictors for disease-specific survival. The median follow-up was 58 months (range: 2–188).Conclusions.Pathologic margin distance is an important predictor of local vulvar recurrence. Our data suggest that a ≥ 8-mm pathologic margin clearance leads to a high rate of loco-regional control.