title: Long-term survival and disease recurrence in patients with primary squamous cell carcinoma of the vulva.
abstract: OBJECTIVE
  To assess time to failure and sites of failure with extended follow-up of patients with squamous cell carcinoma (SCC) of the vulva.
  
  
  METHODS
  A retrospective analysis of 330 patients with primary SCC of the vulva treated at Mayo Clinic between 1955 and 1990 was conducted. The main outcome measures were the rates of treatment failure. The Kaplan-Meier method and the log-rank test were used to estimate the rates of overall survival, disease-free survival, and recurrence. The Cox proportional hazards model was used to assess independent variables as prognostic factors for treatment failure.
  
  
  RESULTS
  All 330 patients in the cohort underwent lymphadenectomy; 113 patients (34.2%) had involvement of the inguinofemoral nodes and 88 patients (26.7%) had treatment failure. Treatment failures occurred more frequently in patients who presented with inguinal metastasis at the primary surgery and during the first 2 years of follow-up. After 2 years, both groups, with or without positive inguinal nodes, had similar treatment failure rates. Most patients with disease recurrence in the groin died within the first 2 years of follow-up. Involvement of the inguinal nodes was the main independent predictive factor for survival, disease recurrence, and metastasis.
  
  
  CONCLUSIONS
  Most treatment failures occurred during the 2 years after initial surgical management. However, in 35% of patients, disease reoccurred 5 years or more after diagnosis, which demonstrates the need for long-term follow-up. Complete ipsilateral or bilateral inguinofemoral lymph node dissection ensures a thorough evaluation and treatment of the groin.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Jesus
authors.initials: J
authors.lastname: Gonzalez Bosquet
authors.forename: Javier F
authors.initials: JF
authors.lastname: Magrina
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gaffey
authors.forename: Jose L
authors.initials: JL
authors.lastname: Hernandez
authors.forename: Maurice J
authors.initials: MJ
authors.lastname: Webb
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*