Multivariate analysis of prognostic factors in primary squamous cell vulvar cancer: The role of perineural invasion in recurrence and survival
| Autor: | Enrico Sartori, Federico Ferrari, Barbera Fernando, Franco Odicino, Sara Forte, Laura Ardighieri, Emma Bonetti |
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| Rok vydání: | 2019 |
| Předmět: |
Oncology
Adult medicine.medical_specialty Multivariate analysis Perineural invasion Subgroup analysis Kaplan-Meier Estimate Disease-Free Survival Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Neoplasm Invasiveness Peripheral Nerves Stage (cooking) Radiation treatment planning Pathological Aged Proportional Hazards Models Retrospective Studies Aged 80 and over 030219 obstetrics & reproductive medicine Vulvar Neoplasms business.industry Margins of Excision General Medicine Vulvar cancer Middle Aged medicine.disease Tumor Burden Survival Rate 030220 oncology & carcinogenesis Cohort Carcinoma Squamous Cell Lymph Node Excision Surgery Female Radiotherapy Adjuvant Neoplasm Recurrence Local business |
| Popis: | to assess the prognostic role in recurrence and survival of perineural invasion (PNI) in vulvar squamous cell cancer (VSCC).Patients underwent primary surgery for VSCC from January 2009 to December 2016 served as the study cohort. We collected demographic, clinical, pathological characteristics and follow-up data, and we compared them among PNI-negative versus -positivepatients. We calculated disease-free survival (DFS) and overall survival (OS) using Kaplan-Meier and univariate log-rank test. We conducted a multivariate analysis with cox-proportional hazard models for DFS and OS, including age, tumor size, depth of invasion, free tumor margin8 mm, high-grade histology, lymph vascular space invasion, PNI, extracapsular lymph nodal disease, lymph nodal ratio0.2 and FIGO Stage 2009 (Early I-II versus Advanced III-IV).We found 74 patients with a PNI prevalence of 31.1%. The 5-year DFS was favourable for PNI-negative patients (72% versus 18%; p = 0.00). The 5-year OS was 75% versus 35% in favor of PNI-negative patients (p = 0.00). The subgroup analysis conducted among stage confirmed a decreased DFS and OS in PNI-positive patients. Multivariate analysis showed that PNI (HR 2.74; CI95% 1.10-7.13; p = 0.03) and extracapsular lymph nodal disease (HR 13.54; CI95% 2.87-64.07; p = 0.01) are independent prognostic factors for earlier recurrence. OS was significantly reduced in case of PNI (HR 4.93; CI95% 1.33-18.35; p = 0.01) and extracapsular lymph nodal disease (HR 10.63; CI95% 1.65-68.57; p = 0.01).PNI is an independent prognostic factor for aggressive behavior and unfavorable course in VSCC and should be considered in adjuvant treatment planning. |
| Databáze: | OpenAIRE |
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