title: Clitoral involvement of squamous cell carcinoma of the vulva: localization with the worst prognosis.
abstract: OBJECTIVE
  The overall 5-year survival of patients with vulvar squamous cell carcinoma (SCC) is 70%. The clinical impression is that localization of SCC on the clitoris may lead to worse prognosis. The aim of this study is to assess the disease specific survival (DSS) in patients with clitoral SCC compared to patients with SCC without clitoral involvement.
  
  
  METHODS
  All consecutive patients with primary vulvar SCC treated with surgery at the Department of Gynaecologic Oncology at the Radboud university medical centre (Radboudumc) between March 1988 and January 2012, were analysed. The clinical and histopathological characteristics and DSS rates of patients with (N = 72) and without clitoral SCC (N = 275) were compared. Furthermore, patients with clitoral involvement were compared to patients with perineal SCCs (N = 52) and other central SCCs without clitoral and/or perineal involvement (N = 117).
  
  
  RESULTS
  Patients with clitoral SCC more often had larger and deeper invaded tumours, lymphovascular space involvement (LVSI), positive surgical margins and a higher percentage of positive lymph nodes. Kaplan-Meier survival analyses showed worse DSS in patients with a clitoral SCC compared to patients without clitoral involvement. Multivariable analysis showed that not clitoral involvement, but invasion depth, differentiation grade and lymph node status are independent prognostic factors.
  
  
  CONCLUSIONS
  Patients with clitoral SCC have worse survival compared to patients without clitoral involvement. This is probably caused by unfavourable histopathological characteristics of the tumour rather than the localization itself. Prospective studies are needed to further assess the influence of localization of the vulvar SCC on prognosis.
authors: Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: Floor.Hinten@radboudumc.nl.
authors: F
authors: F
authors: Hinten
authors: Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors: L C G
authors: LC
authors: van den Einden
authors: Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors: M
authors: M
authors: Cissen
authors: Radboud University Medical Centre, Department for Health Evidence, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors: J
authors: J
authors: IntHout
authors: Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors: L F A G
authors: LF
authors: Massuger
authors: Radboud University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors: J A
authors: JA
authors: de Hullu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D002987:Clitoris / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D010502:Perineum; D011379:Prognosis; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Clitoris; Survival; Vulvar cancer