title: Prognostic factors associated with local recurrence in squamous cell carcinoma of the vulva.
abstract: OBJECTIVE
  To analyze the prognostic factors related to the recurrence rate of vulvar cancer.
  
  
  METHODS
  Retrospective study of 87 patients diagnosed of vulvar squamous cell carcinoma diagnosed at a tertiary hospital in Madrid between January 2000 and December 2010.
  
  
  RESULTS
  The pathological mean tumor size was 35.1±22.8 mm, with stromal invasion of 7.7±6.6 mm. The mean free margin after surgery was 16.8±10.5 mm. Among all patients, 31 (35.6%) presented local recurrence (mean time 10 months; range, 1 to 114 months) and 7 (8%) had distant metastases (mean time, 5 months; range, 1 to 114 months). We found significant differences in the mean tumor size between patients who presented a relapse and those who did not (37.6±21.3 mm vs. 28.9±12.1 mm; p=0.05). Patients with free margins equal or less than 8 mm presented a relapse rate of 52.6% vs. 43.5% of those with free margin greater than 8 mm (p=0.50). However, with a cut-off of 15 mm, we observed a local recurrence rate of 55.6% vs. 34.5%, respectively (p=0.09). When the stromal invasion cut-off was >4 mm, local recurrence rate increased up to 52.9% compared to 37.5% when the stromal invasion was ≤4 mm (p=0.20).
  
  
  CONCLUSIONS
  Tumor size, pathologic margin distance and stromal invasion seem to be the most important predictors of local vulvar recurrence. We consider the cut-off of 35 mm of tumor size, 15 mm tumor-free surgical margin and stromal invasion >4 mm, high risk predictors of local recurrence rate.
authors.affiliation: Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Iacoponi
authors.forename: Ignacio
authors.initials: I
authors.lastname: Zapardiel
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Diestro
authors.forename: Alicia
authors.initials: A
authors.lastname: Hernandez
authors.forename: Javier
authors.initials: J
authors.lastname: De Santiago
keywords: Margin distance; Prognostic factors; Recurrence rate; Vulvar carcinoma