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Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Analyzing the large patient cohort of the multicenter AGO-CaRE-1 study, we compared isolated sentinel lymph node dissection (SLND) with radical lymph node dissection (LND) of the groin in relation to recurrence rates and survival.

Methods

The AGO-CaRE-1 study retrospectively collected data on treatment patterns and follow-up of vulvar cancer patients [International Federation of Gynecology and Obstetrics (FIGO) stage ≥1B] treated at 29 gynecologic cancer centers between 1998 and 2008. This subgroup analysis evaluated the influence of SLND alone on progression-free survival (PFS) and overall survival (OS).

Results

In 487 (63.1%) of 772 included patients with tumors smaller than 4 cm, an LND was performed and no metastatic lymph nodes were detected (LN0). Another 69/772 (8.9%) women underwent SLND alone, showing a negative SLN (SLN0). Tumors in the LN0 group were larger and showed a deeper invasion (LN0 vs. SLN0 tumor diameter: 20.0 vs. 13.0 mm, p < 0.001; depth of invasion: 4.0 vs. 3.0 mm, p = 0.002). After a median follow-up of 33 months (0–156), no significant differences in relation to isolated groin recurrence rates (SLN0 3.0% vs. LN0 3.4%, p = 0.845) were detected. Similarly, univariate 3-year PFS analysis showed no significant differences between both groups (SLN0 82.7% vs. LN0 77.6%, p = 0.230). A multivariate Cox regression analysis, including tumor diameter, depth of invasion, age, grading, and lymphovascular space invasion was performed: PFS [hazard ratio (HR) 0.970, 95% confidence interval (CI) 0.517–1.821] and OS (HR 0.695, 95% CI 0.261–1.849) did not differ significantly between both cohorts.

Conclusion

This subgroup analysis of the large AGO-CaRE-1 study showed similar results for groin LND and SLND alone with regard to recurrence rates and survival in node-negative patients with tumors <4 cm.

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Acknowledgment

The authors thank the statisticians and staff of the Coordinating Center for Clinical Trials of Philipps-University Marburg for their thorough data management, the AGO Study Group staff for their invaluable organizational help, and the Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie (NOGGO) for their support. The authors also thank the additional investigators and staff at the 29 clinical sites for their work with clinical data and follow-up: Kreisklinik Altoetting; Charité – University Medicine Berlin Charité Campus Virchow; University Hospital Carl Gustav Carus Dresden; Evangelisches Krankenhaus Duesseldorf; University Hospital Erlangen-Nuernberg; Essen Kliniken Essen-Mitte; Essen University Hospital; Johann Wolfgang Goethe-University Hospital Frankfurt; Alb Fils Kliniken Goeppingen; University Hospital Freiburg; Georg-August University Hospital Goettingen; Ernst-Moritz-Arndt University Hospital University Medicine Greifswald; University Hospital Halle; Hamburg Albertinen Krankenhaus; University Medical Center Hamburg-Eppendorf; Hannover Medical School; University Hospital Kiel; University Hospital Cologne; Otto-Guericke University Hospital Magdeburg; Philipps-University Marburg; University Hospital Munich Grosshadern; University Hospital Munich RdI; Sana Klinikum Offenbach; Oberhavel Kliniken Oranienburg; Elblandkliniken Radebeul; Städtisches Klinikum Solingen; University Hospital Tuebingen; University Hospital Ulm; Klinikum Wolfsburg.

Conflict of interest

Rüdiger Klapdor, Peter Hillemanns, Linn Wölber, Julia Jückstock, Felix Hilpert, Nikolaus de Gregorio, Severine Iborra, Jalid Sehouli, Anika Habermann, Sophie Teresa Fürst, Hans Georg Strauß, Klaus Baumann, Falk Thiel, Alexander Mustea, Werner Meier, Philipp Harter, Pauline Wimberger, Lars Hanker, Barbara Schmalfeldt, Ulrich Canzler, Tanja Fehm, Alexander Luyten, Martin Hellriegel, Jens Kosse, Christoph Heiss, Peer Hantschmann, Peter Mallmann, Berno Tanner, Jacobus Pfisterer, Barbara Richter, Martin Jäger, and Sven Mahner declare that there are no conflicts of interest involved with the presented data.

Funding

The CaRE-1 study was supported by Medac Oncology without restriction in protocol or analysis.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany

    Rüdiger Klapdor MD & Peter Hillemanns MD

  2. Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Linn Wölber MD

  3. Department of Gynecology and Obstetrics, University of Munich, Munich, Germany

    Julia Jückstock MD, Barbara Schmalfeldt MD & Sven Mahner MD

  4. Jerusalem Hospital, Hamburg, Germany

    Felix Hilpert MD

  5. Department of Gynecology, University of Ulm, Ulm, Germany

    Nikolaus de Gregorio MD

  6. Department of Obstetrics and Gynecology, University Medical Center – RWTH, Aachen, Germany

    Severine Iborra MD

  7. Department of Gynecology, Charité – University Medicine Berlin, Berlin, Germany

    Jalid Sehouli MD

  8. Department of Gynecology, University of Magdeburg, Magdeburg, Germany

    Anika Habermann MD

  9. Department of Gynecology, University of Munich-Grosshadern, Munich, Germany

    Sophie Teresa Fürst MD

  10. Department of Gynecology, University of Halle, Halle, Germany

    Hans Georg Strauß MD

  11. Department of Gynecology, Klinikum Ludwigshafen, Ludwigshafen, Germany

    Klaus Baumann MD

  12. Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany

    Falk Thiel MD & Christoph Heiss MD

  13. Department of Gynecology, University Medicine of Greifswald, Greifswald, Germany

    Alexander Mustea MD

  14. Department of Gynecology, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany

    Werner Meier MD

  15. Department of Gynecology, Kliniken Essen Mitte, Essen, Germany

    Philipp Harter MD

  16. Department of Gynecology and Obstetrics, Carl-Gustav-Carus University Dresden, Dresden, Germany

    Pauline Wimberger MD & Ulrich Canzler MD

  17. Department of Gynecology, UKSH Campus Lübeck, Lübeck, Germany

    Lars Hanker MD

  18. Department of Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany

    Tanja Fehm MD

  19. Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany

    Tanja Fehm MD

  20. Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany

    Alexander Luyten MD

  21. Department of Gynecology, Georg-August-University Goettingen, Goettingen, Germany

    Martin Hellriegel MD

  22. Department of Gynecology, SANA Hospital Offenbach, Offenbach, Germany

    Jens Kosse MD

  23. Department of Gynecology, Hospital Altoettingen, Altoettignen, Germany

    Peer Hantschmann MD

  24. Department of Gynecology, University Hospital Cologne, Cologne, Germany

    Peter Mallmann MD

  25. Oberhavel Hospital, Oranienburg, Germany

    Berno Tanner MD

  26. Gynecologic Oncology Center, Kiel, Germany

    Jacobus Pfisterer MD

  27. Elbland Hospital Meißen-Radebeul, Radebeul, Germany

    Barbara Richter MD

  28. Institute for Biometrics, Hannover Medical School, Hannover, Germany

    Martin Jäger MD

Authors
  1. Rüdiger Klapdor MD
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  2. Peter Hillemanns MD
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  3. Linn Wölber MD
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  4. Julia Jückstock MD
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  5. Felix Hilpert MD
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  7. Severine Iborra MD
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  8. Jalid Sehouli MD
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  9. Anika Habermann MD
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  10. Sophie Teresa Fürst MD
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  11. Hans Georg Strauß MD
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  12. Klaus Baumann MD
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  13. Falk Thiel MD
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  14. Alexander Mustea MD
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  15. Werner Meier MD
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  16. Philipp Harter MD
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  17. Pauline Wimberger MD
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  18. Lars Hanker MD
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  19. Barbara Schmalfeldt MD
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  20. Ulrich Canzler MD
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  21. Tanja Fehm MD
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  22. Alexander Luyten MD
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  23. Martin Hellriegel MD
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  24. Jens Kosse MD
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  25. Christoph Heiss MD
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  26. Peer Hantschmann MD
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  27. Peter Mallmann MD
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  28. Berno Tanner MD
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  29. Jacobus Pfisterer MD
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  30. Barbara Richter MD
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  31. Martin Jäger MD
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  32. Sven Mahner MD
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Corresponding author

Correspondence to Rüdiger Klapdor MD.

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Klapdor, R., Hillemanns, P., Wölber, L. et al. Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study. Ann Surg Oncol 24, 1314–1321 (2017). https://doi.org/10.1245/s10434-016-5687-0

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  • DOI: https://doi.org/10.1245/s10434-016-5687-0

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