title: Clinicopathological prognostic factors and patterns of recurrence in vulvar cancer.
abstract: BACKGROUND
  Vulvar cancer is a rare disease and knowledge on prognostic factors is therefore limited and inconsistent. The aim of this study was to determine prognostic variables for recurrence and survival and to identify patterns of recurrence in patients with vulvar cancer.
  
  
  METHODS
  All patients (n = 103) with primary vulvar cancer treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2003 were retrospectively analysed regarding the prognostic relevance of different clinicopathological variables. Recurrences were evaluated with regard to their characteristics and localisation.
  
  
  RESULTS
  Age, lymph node metastasis, tumor size, depth of invasion and involvement of resection margins predicted poor disease-free and overall survival in univariate analysis. In multivariate analysis, lymph node status was the most important independent prognostic factor (p = 0.002). No correlation was observed between lymph node metastasis and localization of recurrent disease. Regardless of initial nodal involvement, recurrences occurred primarily in the vulvar region.
  
  
  CONCLUSIONS
  Inguinofemoral lymph node status at initial diagnosis is of critical prognostic importance for patients with vulvar cancer. Further tumour biological characteristics need to be identified to stratify patients with nodal involvement for adjuvant radiotherapy of the vulva to prevent local recurrences.
authors.affiliation: Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Linn
authors.initials: L
authors.lastname: Woelber
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
authors.forename: Katharina
authors.initials: K
authors.lastname: Voelker
authors.forename: Christine Zu
authors.initials: CZ
authors.lastname: Eulenburg
authors.forename: Friederike
authors.initials: F
authors.lastname: Gieseking
authors.forename: Matthias
authors.initials: M
authors.lastname: Choschzick
authors.forename: Fritz
authors.initials: F
authors.lastname: Jaenicke
authors.forename: Joerg
authors.initials: J
authors.lastname: Schwarz