title: Prognostic role of inguinal lymphadenectomy in vulvar squamous carcinoma: younger and older patients should be equally treated. A prospective study and literature review.
abstract: OBJECTIVE
  This study analyzed the prognostic significance of nodal involvement in vulvar squamous carcinoma and its correlation with other prognostic factors, focusing the research on comparison between <75 and ≥75years old patients.
  
  
  METHODS
  We prospectively enrolled patients with >1-mm-deep stromal invasion, Ib-III stage vulvar cancer. Patients underwent unilateral or bilateral inguinal lymphadenectomy, according to tumor localization.
  
  
  RESULTS
  In total, 131 patients met inclusion criteria; 93 (71%) underwent bilateral and 38 (29%) unilateral lymphadenectomy with 36 (27%) of them presenting nodal disease. At Kaplan-Meier analysis factors associated to prognosis were nodal status (in very elderly patients also) and number of resected nodes both in bilateral and unilateral lymphadenectomy groups. In univariate analysis, covariates associated with survival included age, in terms of overall survival (OS) but not with disease free-survival (DFS) and disease-specific survival (DSS), grading, nodal status, the presence of bilateral nodal metastases, the number of resected nodes in both unilateral, in terms of OS and DSS but not of DFS and bilateral lymphadenectomy and the number of metastatic nodes. In multivariate analysis covariates associated with survival were age, the number of positive nodes and the number of resected nodes in bilateral lymphadenectomy.
  
  
  CONCLUSIONS
  Results confirm the prognostic role of nodal status in very elderly patients also. Although DSS in older patients resulted worse, lymphadenectomy is not associated with more complications, suggesting its importance in older patients too. Furthermore, the resection of less than 15 lymph nodes in bilateral lymphadenectomy seems to have a negative impact on survival.
authors.affiliation: Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Pierluigi Benedetti
authors.initials: PB
authors.lastname: Panici
authors.affiliation: Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy. Electronic address: federica.tomao@uniroma1.it.
authors.forename: Federica
authors.initials: F
authors.lastname: Tomao
authors.affiliation: Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Domenici
authors.affiliation: Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giannini
authors.affiliation: Service of Biostatistics, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.affiliation: Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Innocenza
authors.initials: I
authors.lastname: Palaia
authors.affiliation: Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Violante
authors.initials: V
authors.lastname: Di Donato
authors.affiliation: Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Musella
authors.affiliation: Department of Gynecologic Oncology, University "Campus Biomedico", Via Alvaro del Portillo 21, 00128 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Angioli
authors.affiliation: Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Muzii
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Lymphadenectomy; Nodal status; Prognosis; Squamous vulvar cancer; Survival; Very elderly patients