Evaluation of treatment, prognostic factors, and survival in 198 vulvar melanoma patients: Implications for clinical practice.

Autor: Boer FL; Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: f.l.boer@lumc.nl., Ten Eikelder MLG; Department of Gynaecology Oncology, Radboud University Medical Centre, the Netherlands., van Geloven N; Department of Biomedical Data Sciences, Leiden University Medical Centre, the Netherlands., Kapiteijn EH; Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands., Gaarenstroom KN; Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands., Hughes G; Department of Gynaecology, Derriford hospital NHS Trust, Plymouth, United Kingdom., Nooij LS; Department of Gynaecology Oncology, Centre for Gynaecologic Oncology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek, the Netherlands., Jozwiak M; Department of Gynaecology Oncology, Erasmus MC Cancer Institute, Erasmus Medical Centre, the Netherlands., Tjiong MY; Department of Gynaecology Oncology, Amsterdam University Medical Centre, the Netherlands., de Hullu JMA; Department of Gynaecology Oncology, Radboud University Medical Centre, the Netherlands., Galaal K; Department of Gynaecology, Royal Cornwall hospital NHS trust, Truro, United Kingdom., van Poelgeest MIE; Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2021 Apr; Vol. 161 (1), pp. 202-210. Date of Electronic Publication: 2021 Jan 26.
DOI: 10.1016/j.ygyno.2021.01.018
Abstrakt: Objective: To identify clinicopathological characteristics, treatment patterns, clinical outcomes and prognostic factors in patients with vulvar melanoma (VM).
Materials & Methods: This retrospective multicentre cohort study included 198 women with VM treated in eight cancer centres in the Netherlands and UK between 1990 and 2017. Clinicopathological features, treatment, recurrence, and survival data were collected. Overall and recurrence-free survival was estimated with the Kaplan-Meier method. Prognostic parameters were identified with multivariable Cox regression analysis.
Results: The majority of patients (75.8%) had localized disease at diagnosis. VM was significantly associated with high-risk clinicopathological features, including age, tumour thickness, ulceration, positive resection margins and involved lymph nodes. Overall survival was 48% (95% CI 40-56%) and 31% (95% CI 23-39%) after 2 and 5 years respectively and did not improve in patients diagnosed after 2010 compared to patients diagnosed between 1990 and 2009. Recurrence occurred in 66.7% of patients, of which two-third was non-local. In multivariable analysis, age and tumour size were independent prognostic factors for worse survival. Prognostic factors for recurrence were tumour size and tumour type. Only the minority of patients were treated with immuno- or targeted therapy.
Conclusion: Our results show that even clinically early-stage VM is an aggressive disease associated with poor clinical outcome due to distant metastases. Further investigation into the genomic landscape and the immune microenvironment in VM may pave the way to novel therapies to improve clinical outcomes in these aggressive tumours. Clinical trials with immunotherapy or targeted therapy in patients with high-risk, advanced or metastatic disease are highly needed.
Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest. Authors have full control of all primary data. They agree to allow the journal to review the data if requested.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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