Lymph node (LN) metastasis is the most important prognostic factor in primary vulvar
cancer. Assessing risk factors for the incidence and extent of LN metastases may help
to select the optimal treatment strategy for each individual patient.
In a subgroup analysis of the large multicenter AGO-CaRE-1 study we included all patients
treated with radical groin dissection. Univariate and multivariate regression analyses
were performed in order to detect factors associated with the prevalence and extent
of nodal involvement.
In total, 1162 patients were analyzed. Univariate analyses detected age, ECOG as well
as multiple tumor characteristics such as FIGO stage, grading, depth of invasion,
tumor diameter, and (lymph)vascular space invasion to be related with the prevalence
of LN metastases. Interestingly, only tumor stage, tumor diameter and depth of infiltration
were found to be significantly associated with the number of LN metastases. In multivariate
analysis, age (OR 1.03), lymphvascular space invasion (OR 4.97), tumor stage (OR 2.22)
and depth of infiltration (OR 1.08) showed an association with the prevalence of LN
metastases. Regarding the number of metastatic LNs, only tumor stage (OR 2.21) or,
if excluded, tumor diameter (OR 1.02) were tested significant.
This large analysis of the multicenter AGO-CaRE-1-study identified lymphvascular space
invasion, tumor stage, and depth of infiltration as factors with the strongest association
regarding the prevalence of LN metastasis. Interestingly, tumor stage or, if excluded,
tumor diameter were the only factors associated with the prevalence as well as the
extent of LN metastases.