title: Prognostic factors for recurrence and survival among patients with invasive vulvar Paget disease included in the VULCAN study.
abstract: OBJECTIVE
  To identify prognostic factors associated with recurrence and overall survival among patients with invasive vulvar Paget disease.
  
  
  METHODS
  An analysis was conducted of patients with invasive vulvar Paget disease included in VULCAN, an international multicenter retrospective study of patients diagnosed with vulvar cancer between January 1, 2001, and December 31, 2005. Data regarding diagnosis, treatment, and follow-up were obtained from the patients' medical records. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Among 1727 patients registered in the VULCAN database, 38 patients had invasive vulvar Paget disease. The mean follow-up time for these patients was 44.1±35.7 months, the overall recurrence rate (local lesions and distant metastases) was 58%, and the mean overall survival time was 58.5±0.5 months. Case load at the treating center inversely correlated with local recurrence (P=0.01). Tumor size and FIGO stage were associated with the presence of distant metastases (P<0.001 for both). Adjuvant therapy (radiotherapy or chemotherapy) was associated with a reduced risk of distant metastases and increased overall survival (P<0.001 for both).
  
  
  CONCLUSIONS
  Local recurrences of invasive vulvar Paget disease were associated with the case load at the treating center. Distant recurrences were associated with tumor size and FIGO stage. It is possible that adjuvant radiotherapy or chemotherapy could offer patients benefits by increasing overall survival rates.
authors: Gynecologic Oncology Unit, La Paz University Hospital, IdiPAZ, Madrid, Spain.
authors: Sara
authors: S
authors: Iacoponi
authors: Department of Obstetrics, Gynecology and Oncology, 2nd Faculty of Medicine, Warsaw Medical University, Warsaw, Poland; Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland.
authors: Kamil
authors: K
authors: Zalewski
authors: Department of Gynecologic Oncology, San Gerardo Hospital, Monza, Italy.
authors: Robert
authors: R
authors: Fruscio
authors: Gynecology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Begoña
authors: B
authors: Diaz-De la Noval
authors: Gynecology Department, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors: Pierandrea
authors: P
authors: De Iaco
authors: Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery Unit, International School of Surgical Anatomy, 'Sacred Heart' Hospital, Verona, Italy.
authors: Marcello
authors: M
authors: Ceccaroni
authors: Gynecologic Oncology Department, Ciudad Sanitaria de Bellvitge, Barcelona, Spain.
authors: Dib
authors: D
authors: Barazi
authors: Gynecology Department, Campus Virchow-Klinikum, Charité-University Medicine, Berlin, Germany.
authors: Frank
authors: F
authors: Chen
authors: Gynecologic Oncology Unit, La Paz University Hospital, IdiPAZ, Madrid, Spain. Electronic address: ignaciozapardiel@hotmail.com.
authors: Ignacio
authors: I
authors: Zapardiel
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D010145:Paget Disease, Extramammary / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000628:therapy
keywords: Invasive Paget disease; Local recurrence; Overall survival; Prognostic factors; Vulvar Paget disease; Vulvar cancer