Highlights
- •Analysis of the margin relevance in a uniform node-negative vulvar cancer cohort.
- •15.9% (46/289) patients developed recurrence, thereof 34 (11.8%) at the vulva.
- •Vulvar recurrence rates: 12.6% with a margin <8 mm and 10.2% with a margin ≥8 mm.
- •This study fails to confirm the need for a pathological margin distance ≥8 mm.
Abstract
Aim of the study
A tumour-free pathological resection margin of ≥8 mm is considered state-of-the-art.
Available evidence is based on heterogeneous cohorts. This study was designed to clarify
the relevance of the resection margin for loco-regional control in vulvar cancer.
Methods
AGO-CaRE-1 is a large retrospective study. Patients (n = 1618) with vulvar cancer ≥ FIGO stage IB treated at 29 German gynecologic-cancer-centres
1998–2008 were included. This subgroup analysis focuses on solely surgically treated
node-negative patients with complete tumour resection (n = 289).
Results
Of the 289 analysed patients, 141 (48.8%) had pT1b, 140 (48.4%) pT2 and 8 (2.8%) pT3
tumours. One hundred twenty-five (43.3%) underwent complete vulvectomy, 127 (43.9%)
partial vulvectomy and 37 (12.8%) radical local excision. The median minimal resection
margin was 5 mm (1 mm–33 mm); all patients received groin staging, in 86.5% with full
dissection. Median follow-up was 35.1 months. 46 (15.9%) patients developed recurrence,
thereof 34 (11.8%) at the vulva, after a median of 18.3 months. Vulvar recurrence
rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin
≥8 mm. When analysed as a continuous variable, the margin distance had no statistically
significant impact on local recurrence (HR per mm increase: 0.930, 95% CI: 0.849–1.020;
p = 0.125). Multivariate analyses did also not reveal a significant association between
the margin and local recurrence neither when analysed as continuous variable nor categorically
based on the 8 mm cutoff. Results were consistent when looking at disease-free-survival
and time-to-recurrence at any site (HR per mm increase: 0.949, 95% CI: 0.864–1.041;
p = 0.267).
Conclusions
The need for a minimal margin of 8 mm could not be confirmed in the large and homogeneous
node-negative cohort of the AGO-CaRE database.
Keywords
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Article info
Publication history
Published online: November 09, 2016
Accepted:
September 26,
2016
Received in revised form:
September 8,
2016
Received:
July 16,
2016
Footnotes
☆This study was presented in part at ASCO Annual Meeting 2014.
Identification
Copyright
© 2016 Elsevier Ltd. All rights reserved.
