title: Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study.
abstract: OBJECTIVE
  Analyzing the large patient cohort of the multicenter AGO-CaRE-1 study, we compared isolated sentinel lymph node dissection (SLND) with radical lymph node dissection (LND) of the groin in relation to recurrence rates and survival.
  
  
  METHODS
  The AGO-CaRE-1 study retrospectively collected data on treatment patterns and follow-up of vulvar cancer patients [International Federation of Gynecology and Obstetrics (FIGO) stage ≥1B] treated at 29 gynecologic cancer centers between 1998 and 2008. This subgroup analysis evaluated the influence of SLND alone on progression-free survival (PFS) and overall survival (OS).
  
  
  RESULTS
  In 487 (63.1%) of 772 included patients with tumors smaller than 4 cm, an LND was performed and no metastatic lymph nodes were detected (LN0). Another 69/772 (8.9%) women underwent SLND alone, showing a negative SLN (SLN0). Tumors in the LN0 group were larger and showed a deeper invasion (LN0 vs. SLN0 tumor diameter: 20.0 vs. 13.0 mm, p < 0.001; depth of invasion: 4.0 vs. 3.0 mm, p = 0.002). After a median follow-up of 33 months (0-156), no significant differences in relation to isolated groin recurrence rates (SLN0 3.0% vs. LN0 3.4%, p = 0.845) were detected. Similarly, univariate 3-year PFS analysis showed no significant differences between both groups (SLN0 82.7% vs. LN0 77.6%, p = 0.230). A multivariate Cox regression analysis, including tumor diameter, depth of invasion, age, grading, and lymphovascular space invasion was performed: PFS [hazard ratio (HR) 0.970, 95% confidence interval (CI) 0.517-1.821] and OS (HR 0.695, 95% CI 0.261-1.849) did not differ significantly between both cohorts.
  
  
  CONCLUSIONS
  This subgroup analysis of the large AGO-CaRE-1 study showed similar results for groin LND and SLND alone with regard to recurrence rates and survival in node-negative patients with tumors <4 cm.
authors.affiliation: Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany. klapdor.ruediger@mh-hannover.de.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Klapdor
authors.affiliation: Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
authors.affiliation: Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Linn
authors.initials: L
authors.lastname: Wölber
authors.affiliation: Department of Gynecology and Obstetrics, University of Munich, Munich, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Jückstock
authors.affiliation: Jerusalem Hospital, Hamburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Hilpert
authors.affiliation: Department of Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: de Gregorio
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center - RWTH, Aachen, Germany.
authors.forename: Severine
authors.initials: S
authors.lastname: Iborra
authors.affiliation: Department of Gynecology, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
authors.affiliation: Department of Gynecology, University of Magdeburg, Magdeburg, Germany.
authors.forename: Anika
authors.initials: A
authors.lastname: Habermann
authors.affiliation: Department of Gynecology, University of Munich-Grosshadern, Munich, Germany.
authors.forename: Sophie Teresa
authors.initials: ST
authors.lastname: Fürst
authors.affiliation: Department of Gynecology, University of Halle, Halle, Germany.
authors.forename: Hans Georg
authors.initials: HG
authors.lastname: Strauß
authors.affiliation: Department of Gynecology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Baumann
authors.affiliation: Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Thiel
authors.affiliation: Department of Gynecology, University Medicine of Greifswald, Greifswald, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mustea
authors.affiliation: Department of Gynecology, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Meier
authors.affiliation: Department of Gynecology, Kliniken Essen Mitte, Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.affiliation: Department of Gynecology and Obstetrics, Carl-Gustav-Carus University Dresden, Dresden, Germany.
authors.forename: Pauline
authors.initials: P
authors.lastname: Wimberger
authors.affiliation: Department of Gynecology, UKSH Campus Lübeck, Lübeck, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Hanker
authors.affiliation: Department of Gynecology and Obstetrics, University of Munich, Munich, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schmalfeldt
authors.affiliation: Department of Gynecology and Obstetrics, Carl-Gustav-Carus University Dresden, Dresden, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Canzler
authors.affiliation: Department of Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany.|Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Fehm
authors.affiliation: Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Luyten
authors.affiliation: Department of Gynecology, Georg-August-University Goettingen, Goettingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hellriegel
authors.affiliation: Department of Gynecology, SANA Hospital Offenbach, Offenbach, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Kosse
authors.affiliation: Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Heiss
authors.affiliation: Department of Gynecology, Hospital Altoettingen, Altoettignen, Germany.
authors.forename: Peer
authors.initials: P
authors.lastname: Hantschmann
authors.affiliation: Department of Gynecology, University Hospital Cologne, Cologne, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Mallmann
authors.affiliation: Oberhavel Hospital, Oranienburg, Germany.
authors.forename: Berno
authors.initials: B
authors.lastname: Tanner
authors.affiliation: Gynecologic Oncology Center, Kiel, Germany.
authors.forename: Jacobus
authors.initials: J
authors.lastname: Pfisterer
authors.affiliation: Elbland Hospital Meißen-Radebeul, Radebeul, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Richter
authors.affiliation: Institute for Biometrics, Hannover Medical School, Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Jäger
authors.affiliation: Department of Gynecology and Obstetrics, University of Munich, Munich, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000601:surgery*; D015996:Survival Rate; D047368:Tumor Burden; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult