Role of pelvic lymph node resection in vulvar cancer – a subset analysis of the AGO-CaRE-1 study

Background The recommendation for pelvic lymphadenectomy (LAE) in VSCC has changed fundamentally since the S2k-Guideline was published in 2015; herein LAE in patients at risk for pelvic nodal involvement is advised. However, the population at risk is poorly defined.

Patients and Methods In the AGO-CaRE-1 study 1618 patients with primary VSCC FIGO stage≥1B, treated at 29 centers in Germany 1998-2008, were documented. In this subanalysis patients with pelvic LAE (n = 70) were analyzed.

Results The majority had T1b/T2 tumors (n = 47;67.1 %) with a median diameter of 40mm(2-240mm). 42/70 patients were inguinally node-positive. Pelvic nodal involvement without groin metastases was not observed. 14/42 patients had pelvic nodal metastases (33 %; median number of affected pelvic nodes 2.5(1-12)). These 14 patients had in median 7 (1-30) affected groin nodes with a median maximum diameter of metastasis of 42.5mm (12-50). The number of affected groin and pelvic nodes was available for 12 patients: 10 had ≥6 positive lymph-nodes in the groins, one patient had 3 and another patient a single groin metastasis. ROC analytics showed an AUC of 0.85 with 83.3 % sensitivity and 92.6 % specificity for the prediction of pelvic involvement in case of ≥6 positive groin nodes. No pelvic recurrences were observed in the pelvic positive group; 28.6 % experienced recurrences at distant sites (4/14). Pelvic metastasis correlated with a progression-free survival of only 12.5 months.

Conclusion For the majority of node-positive patients with VSCC pelvic nodal staging is unnecessary. A relevant risk for pelvic nodal involvement seems only to be present in highly node-positive disease.

Publication History

Article published online:
07 October 2020