title: Predictors and Patterns of Local, Regional, and Distant Failure in Squamous Cell Carcinoma of the Vulva.
abstract: OBJECTIVE
  To identify factors predicting for recurrence in vulvar cancer patients undergoing surgical treatment.
  
  
  METHODS
  We retrospectively evaluated data of consecutive patients with squamous cell vulvar cancer treated between January 1, 1990 and December 31, 2013. Basic descriptive statistics and multivariable analysis were used to design predicting models influencing outcomes. Five-year disease-free survival (DFS) and overall survival (OS) were analyzed using the Cox model.
  
  
  RESULTS
  The study included 101 patients affected by vulvar cancer: 64 (63%) stage I, 12 (12%) stage II, 20 (20%) stage III, and 5 (5%) stage IV. After a mean (SD) follow-up of 37.6 (22.1) months, 21 (21%) recurrences occurred. Local, regional, and distant failures were recorded in 14 (14%), 6 (6%), and 3 (3%) patients, respectively. Five-year DFS and OS were 77% and 82%, respectively. At multivariate analysis only stromal invasion >2 mm (hazard ratio: 4.9 [95% confidence interval, 1.17-21.1]; P=0.04) and extracapsular lymph node involvement (hazard ratio: 9.0 (95% confidence interval, 1.17-69.5); P=0.03) correlated with worse DFS, although no factor independently correlated with OS. Looking at factors influencing local and regional failure, we observed that stromal invasion >2 mm was the only factor predicting for local recurrence, whereas lymph node extracapsular involvement predicted for regional recurrence.
  
  
  CONCLUSIONS
  Stromal invasion >2 mm and lymph node extracapsular spread are the most important factors predicting for local and regional failure, respectively. Studies evaluating the effectiveness of adjuvant treatment in high-risk patients are warranted.
authors.affiliation: *Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese †Department of Obstetrics and Gynecology, Sapienza University Hospital, Roma ‡Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Violante Di
authors.initials: VD
authors.lastname: Donato
authors.forename: Jvan
authors.initials: J
authors.lastname: Casarin
authors.forename: Edoardo Di
authors.initials: ED
authors.lastname: Naro
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery