title: Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis.
abstract: OBJECTIVE
  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 > or =8-mm pathologic margin clearance leads to a high rate of loco-regional control.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA. john.chan@stanford.edu
authors.forename: John K
authors.initials: JK
authors.lastname: Chan
authors.forename: Valerie
authors.initials: V
authors.lastname: Sugiyama
authors.forename: Huyen
authors.initials: H
authors.lastname: Pham
authors.forename: Mai
authors.initials: M
authors.lastname: Gu
authors.forename: Joanne
authors.initials: J
authors.lastname: Rutgers
authors.forename: Kathryn
authors.initials: K
authors.lastname: Osann
authors.forename: Michael K
authors.initials: MK
authors.lastname: Cheung
authors.forename: Michael L
authors.initials: ML
authors.lastname: Berman
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Disaia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*