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Incidence of inguinofemoral lymph node metastases at the first local recurrence of vulvar cancer: a Dutch nationwide study

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Abstract

Background

Up to 40% of vulvar cancer patients present with local recurrence within 10 years of follow-up. An inguinofemoral lymphadenectomy (IFL) is indicated if not performed at primary treatment. The incidence and risk factors for lymph node metastases (LNM) at first local recurrence, however, are unclear. Our aim was to determine the incidence of LNM at first local recurrence, in relation to previous groin treatment and clinicopathological factors.

Methods

A multicenter cohort study including vulvar cancer patients with a first macroinvasive local recurrence after primary surgical treatment between 2000 and 2015 was conducted in the Netherlands. Groin status at local recurrence was defined as positive (N+), negative (N−) or unknown (N?) and based on histology, imaging and follow-up. Patient-, tumour- and treatment characteristics of primary and recurrent disease were analysed.

Results

Overall, 16.3% (66/404) had a N+ groin status at first local recurrence, 66.4% (268/404) N− and 17.3% (70/404) N? groin status. The incidence of a N+ groin status was comparable after previous SLN and IFL, 11.5% and 13.8%, respectively. A N+ groin status was related to tumour size (25 vs.12 mm; P < 0.001), depth of invasion (5 vs. 3 mm; P < 0.001) and poorly differentiated tumours (22.9 vs. 11.9%; P = 0.050) at local recurrence.

Conclusions

The incidence of LNM at first local recurrence in vulvar cancer patients was 16.3%, and independent of previous type of groin surgery. In accordance with primary diagnosis, tumour size, depth of invasion, and tumour grade were significantly associated with a positive groin status.

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Fig. 1
Fig. 2: Groin status at first local recurrence of vulvar cancer (N = 404).
Fig. 3: Positive groin status at local recurrence in relation to type of groin surgery at primary treatment (n = 66).
Fig. 4: Positive groin status at local recurrence in patients with SLN procedure at primary treatment (n = 187).
Fig. 5: Positive groin status at recurrence in patients with previous IFL (n = 136).
Fig. 6: Time to first local recurrence of vulvar cancer.

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Data availability

All data generated or analysed during this study are included in this published article (and its supplementary information files).

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Acknowledgements

Published conference abstracts: in an earlier stage of the study, the abstract was presented at the European Society of Gynecological Oncology (ESGO) meeting in 2019 [30]. Additional contributions: Martijn Mensink, Anouk van Heertum and Anne Hompesch are medical (Master of Science) students and were involved in the data collection process as part of their thesis.

Funding

The author(s) received no specific funding for this work.

Author information

Author notes

  1. Noortje Pleunis

    Present address: Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands

    Noortje Pleunis, Anne-Floor W. Pouwer, Johanna M. A. Pijnenborg & Joanne A. de Hullu

  2. Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

    Maaike H. M. Oonk

  3. Department of Gynaecological Oncology, ErasmusMC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands

    Helena C. van Doorn

  4. Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands

    Ming Y. Tjiong & Jacobus van der Velden

  5. Department of Gynaecological Oncology, Antoni van Leeuwenhoek, Amsterdam, the Netherlands

    Henry Zijlmans

  6. Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands

    Mariette I. E. van Poelgeest

  7. Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands

    Eleonora B. van Dorst

  8. Department of Obstetrics and Gynaecology, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, Maastricht, the Netherlands

    Brigitte F. M. Slangen

  9. Department of Radiotherapy, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, the Netherlands

    Lia C. G. Verhoef

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Contributions

Conceptualisation: JdH, HP, NP and AFP. Data curation: NP, AFP, MO, HvD, MT, JvdV, HZ, MvP, EvD and BS. Formal Analysis: NP, JdH and HP. Methodology: NP, AFP, JdH and HP. Supervision: JdH and HP. Writing—original draft: NP. Writing—review and editing: NP, AFP, MO, HvD, MT, JvdV, HZ, MvP, EvD, BS and CV.

Corresponding author

Correspondence to Noortje Pleunis.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the medical ethics committee at the Radboud University Medical Center (case file number 2017–3475) and all local ethics committees. All required data had been previously registered during medical treatment and records were anonymized. The study was performed in accordance with the Declaration of Helsinki.

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Supplementary information

Supplement 1; Localization of primary tumor in relation to first local recurrence (n = 338)

41416_2023_2373_MOESM2_ESM.docx

Supplement 2; Exploration of reasons for refraining from surgical treatment in patients with N+ groin status at local recurrence on basis of positive imaging (n = 10)

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Pleunis, N., Pouwer, AF.W., Oonk, M.H.M. et al. Incidence of inguinofemoral lymph node metastases at the first local recurrence of vulvar cancer: a Dutch nationwide study. Br J Cancer 129, 956–964 (2023). https://doi.org/10.1038/s41416-023-02373-0

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