Journal Article

Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study

de Gregorio, Nikolaus, Baumann, Klaus, Harter, Philipp, Sehouli, Jalid, Wimberger, Pauline, Fürst, Sophie Teresa, Hillemanns, Peter, Jückstock, Julia, Hantschmann, Peer, Fehm, Tanja, Richter, Barbara, Iborra, Severine, Klapdor, Rüdiger, Luyten, Alexander, Mallmann, Peter, Pfisterer, Jacobus, Hilpert, Felix, Wölber, Linn, Habermann, Anika, Kosse, Jens, Meier, Werner, Canzler, Ulrich, Strauß, Hans Georg, Tanner, Berno, Thiel, Falk, Hellriegel, Martin, Hanker, Lars, Jäger, Martin, Schmalfeldt, Barbara, Mahner, Sven, Mustea, Alexander, Heiss, Christoph

2017

Overview

Purpose Analyzing the large patient cohort of the multicenter AGO-CaRE-1 study, we compared isolated sentinel lymph node dissection (SLND) with radical lymph node dissection (LND) of the groin in relation to recurrence rates and survival. Methods The AGO-CaRE-1 study retrospectively collected data on treatment patterns and follow-up of vulvar cancer patients [International Federation of Gynecology and Obstetrics (FIGO) stage ≥1B] treated at 29 gynecologic cancer centers between 1998 and 2008. This subgroup analysis evaluated the influence of SLND alone on progression-free survival (PFS) and overall survival (OS). Results In 487 (63.1%) of 772 included patients with tumors smaller than 4 cm, an LND was performed and no metastatic lymph nodes were detected (LN0). Another 69/772 (8.9%) women underwent SLND alone, showing a negative SLN (SLN0). Tumors in the LN0 group were larger and showed a deeper invasion (LN0 vs. SLN0 tumor diameter: 20.0 vs. 13.0 mm, p  < 0.001; depth of invasion: 4.0 vs. 3.0 mm, p  = 0.002). After a median follow-up of 33 months (0–156), no significant differences in relation to isolated groin recurrence rates (SLN0 3.0% vs. LN0 3.4%, p  = 0.845) were detected. Similarly, univariate 3-year PFS analysis showed no significant differences between both groups (SLN0 82.7% vs. LN0 77.6%, p  = 0.230). A multivariate Cox regression analysis, including tumor diameter, depth of invasion, age, grading, and lymphovascular space invasion was performed: PFS [hazard ratio (HR) 0.970, 95% confidence interval (CI) 0.517–1.821] and OS (HR 0.695, 95% CI 0.261–1.849) did not differ significantly between both cohorts. Conclusion This subgroup analysis of the large AGO-CaRE-1 study showed similar results for groin LND and SLND alone with regard to recurrence rates and survival in node-negative patients with tumors <4 cm.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Age Factors / Aged / Aged, 80 and over / Disease-Free Survival / Female / Follow-Up Studies / Gynecologic Oncology / Humans / Inguinal Canal / Lymph Node Excision - methods / Lymphatic Metastasis / Medicine / Medicine & Public Health / Middle Aged / Neoplasm Grading / Neoplasm Invasiveness / Neoplasm Recurrence, Local - surgery / Neoplasm Staging / Oncology / Retrospective Studies / Sentinel Lymph Node - surgery / Surgery / Surgical Oncology / Survival Rate / Tumor Burden / Vulvar Neoplasms - pathology / Vulvar Neoplasms - surgery / Young Adult