title: Gynecologic Oncology Group risk groups for vulvar carcinoma: improvement in survival in the modern era.
abstract: OBJECTIVE
  Patients with vulvar cancer were stratified into risk groups for survival based on surgicopathologic findings from a prospective study conducted by the Gynecologic Oncology Group from 1977-1984. The purpose of this study is to reassess these risk groups in patients treated in an era of contemporary management.
  
  
  METHODS
  Patients with vulvar carcinoma were identified from 1990-2005 for retrospective analysis. Charts were abstracted for clinical, histopathologic and surgical data, and patients stratified into four risk groups for survival based on the clinical size of tumor and extent of lymph node metastasis. Univariate and multivariate characteristics were evaluated and 5-year survival determined by Kaplan-Meier method.
  
  
  RESULTS
  175 patients were identified that underwent surgical management with a median age at diagnosis of 59.9 years. Stage distribution included: I (n=89, 51%), II (n=53, 30%), III (n=29, 17%), and IV (n=4, 2%). Stratification into risk groups included: minimal (n=89, 51%), low (n=69, 40%), intermediate (n=11, 6%), and high (n=6; 3%). The survival rate was 100%, 97%, 82% and 100%, respectively, at median follow-up of 54.5 months. Comparatively, the survival rates for historic groups were 97.9%, 87.4%, 74.8% and 29.0%. Using multivariate analysis, age (p=0.04) and lymph node metastasis (p=0.009) were predictive of survival.
  
  
  CONCLUSIONS
  Survival among the minimal and low risk groups is preserved in spite of less radical surgery. 5-year survival rate for intermediate and high risk patients also appears to be improved. This is likely a result of advancement in adjuvant chemo-radiation and a younger patient population that presents with less advanced disease.
authors.affiliation: Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Oklahoma University Health Sciences Center, PO Box 26901, WP2410, Oklahoma City, OK 73190, USA. Lisa-landrum@ouhsc.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Landrum
authors.forename: Grainger S
authors.initials: GS
authors.lastname: Lanneau
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Skaggs
authors.forename: Natalie
authors.initials: N
authors.lastname: Gould
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.forename: D Scott
authors.initials: DS
authors.lastname: McMeekin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gold
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*