Prognostic Factors for Vulvar Cancer Undergoing Primary Surgery: Case Series from a Single Tertiary Cancer Center

To evaluate clinical outcomes in women undergoing primary surgery for vulvar squamous cell carcinoma) (SCC) with an aim to identify surgico-pathological risk factors associated with recurrence and survival. Retrospective cohort analysis was carried out between January 2011 and December 2018 for patients with vulvar SCC who underwent primary surgery. The Kaplan-Meier method was used for the estimation of the probability of disease-free survival (DFS) and overall survival (OS). Univariate and multivariate analyses based on the Cox proportional hazards model were performed to identify factors associated with DFS and OS. A p-value <= 0.05 in a two-tailed test was considered statistically significant. The study population included 81 patients; the median follow-up time for the entire cohort was 41 months. Recurrence was noted in 27 cases (33.3%), and the median time to recurrence was 36.14 months. The median overall survival (OS) was 40.8 months, and disease-free survival (DFS) was 36 months. On univariate analysis, depth of invasion (DOI), close margin, presence of lympho-vascular space invasion (LVSI), perineural invasion (PNI), groin metastases, and not receiving adjuvant therapy were significantly associated with increased recurrence rates. Deeper stromal invasion, presence of LVSI, groin node metastases, and recurrent disease were associated with poor OS on univariate analysis. On multivariate analysis, DOI, tumor-free margin (TFM), and PNI were significantly associated with DFS, and a previous history of recurrence was associated with OS. Vulvar cancers are relatively rare tumors with several local tumor factors such as TFM, DOI, LVSI, and lymph node status which may help determine oncological outcomes. Larger studies will definitely help establish more evidence.