title: Clinical and pathological prognostic factors in squamous cell carcinoma of the vulva.
abstract: OBJECTIVE
  The objective of this study was the prognostic analysis of clinicopathologic variables related to primary tumor and to lymph node metastases.
  
  
  METHODS
  We retrospectively analyzed 389 cases of squamous cell carcinoma of the vulva. The following variables were studied: patients' age, diameter and location of the tumor, clinical tumor characteristics, depth of invasion, grade, lymphovascular space involvement (LVSI) and lymph node status. In the subset of 110 node positive patients, we evaluated number of positive nodes, laterality, extension of node dissection, lymph node chains involved, presence of extracapsular spread and rate of lymph node replacement. All variables with P value < 0.2 by the univariate analysis were successively subjected to multivariate analysis (Cox proportional hazard model).
  
  
  RESULTS
  Among all the tumor-related variables age, clinical tumor characteristics, LVSI and lymph node status were found to be statistically significant predictors of survival for the log-rank test. On the basis of multivariate analysis, the nodal status was the most significant independent prognostic factor (hazard rate [HR]: 2.06; confidence interval [CI] 95%: 1.57-12.07) followed by LVSI (HR: 3.47; CI95%: 1.85-7.85). The independent prognostic factors among the variables relative to positive nodes were the percentage of nodal replacement (HR: 6.99; CI95%: 3.51-16.14) and the extracapsular spread (HR: 4.88; CI95%: 2.96-10.14).
  
  
  CONCLUSIONS
  Lymph node status and nodal features, such as extracapsular spread and nodal replacement rate, were shown to be independent factors. These factors should be considered to identify high risk patients and in planning further adjuvant therapy.
authors.affiliation: Department of Gynecologic Oncology, Istituto Nazionale Tumori, via Venezian 1, 20133 Milan, Italy. francesco.hanozet@istitutotumori.mi.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
authors.forename: Francesco
authors.initials: F
authors.lastname: Hanozet
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.forename: Eugenio
authors.initials: E
authors.lastname: Solima
authors.forename: Flavia
authors.initials: F
authors.lastname: Zanaboni
authors.forename: Francesca
authors.initials: F
authors.lastname: Vecchione
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000473:pathology*