Predictors and Patterns of Recurrence in Vulvar Cancer

Abstract

Objective: To identify prognostic factors predicting recurrence in vulvar cancer patients undergoing surgery.

Methods: We retrospectively evaluated data from consecutive patients with vulvar cancer treated between 2002 and 2024 in 2 Italian centers. Basic descriptive statistics and multivariable analysis were used to create predictive models for patient outcomes. Five-year disease-free survival (DFS) and overall survival (OS) were analyzed using a Cox proportional hazards model.

Results: The study included 283 patients diagnosed with vulvar cancer (239 with squamous cell carcinoma). The most frequent stages were stage I (50.9%) and stage III (30.4%). After a median follow-up of 27 months, 91 (32.2%) recurrences were observed, of which 20% were local, 6% were regional, and 6% were distant. The five-year DFS and OS were 46% and 60%, respectively. Multivariate analysis identified the presence of positive lymph nodes (hazard ratio [HR]: 3.54, 95% confidence interval [CI]: 1.04-12.08), age (HR: 1.02, 95% CI: 1-1.04), FIGO stage II (HR: 3.12, 95% CI: 1.24-7.87), and FIGO stage IV (HR: 3.85, 95% CI: 1.19-12.43) as factors associated with worse DFS. Positive nodes (HR: 2.64, 95% CI: 1.2-5.8) and tumor diameter >4 cm (HR: 1.89, 95% CI: 1.05-3.42) were associated with OS. FIGO stage >I was predictive of regional and distant recurrences, but no factor was found to correlate with local recurrence.

Conclusions: FIGO stage >I was predictive of regional and distant recurrences, while no factors influencing local recurrence were identified. Positive nodes, age, and FIGO stage >I correlated with DFS, whereas tumor diameter >4 cm and positive nodes influenced OS.

Keywords: patterns; predictors; recurrence; vulva.