Pelvic Lymphadenectomy in Vulvar Cancer – Does it make sense?

Linn Woelber; Mareike Bommert; Katharina Prieske; Inger Fischer; Christine zu Eulenburg; Eik Vettorazzi; Philipp Harter; Julia Jueckstock; Felix Hilpert; Niko de Gregorio; Severine Iborra; Jalid Sehouli; Atanas Ignatov; Peter Hillemanns; Sophie Fuerst; Hans-Georg Strauss; Klaus Baumann; Matthias Beckmann; Alexander Mustea; Werner Meier; Pauline Wimberger; Lars Hanker; Ulrich Canzler; Tanja Fehm; Alexander Luyten; Martin Hellriegel; Jens Kosse; Christoph Heiss; Peer Hantschmann; Peter Mallmann; Berno Tanner; Jacobus Pfisterer; Sven Mahner; Barbara Schmalfeldt; Anna Jaeger

doi:10.1055/a-1120-0138

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(12): 1221-1228
DOI: 10.1055/a-1120-0138

GebFra Science

Review/Übersicht

Pelvine Lymphonodektomie beim Vulvakarzinom – Wohl oder Übel?

Article in several languages: English | deutsch

Linn Woelber

¹Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Mareike Bommert

²Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany

,

Katharina Prieske

¹Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

²⁸Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Inger Fischer

¹Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Christine zu Eulenburg

³Department of Epidemiology, UMCG, Universität Groningen, Groningen, Netherlands

,

Eik Vettorazzi

⁴Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Philipp Harter

²Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany

,

Julia Jueckstock

⁵Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany

,

Felix Hilpert

⁶Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany

,

Niko de Gregorio

⁷Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany

,

Severine Iborra

⁸Gynecology and Gynecologic Oncology, Uniklinik RWTH Aachen, Aachen, Germany

,

Jalid Sehouli

⁹Department of Gynecology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany

,

Atanas Ignatov

¹⁰Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany

,

Peter Hillemanns

¹¹Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany

,

Sophie Fuerst

⁵Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany

,

Hans-Georg Strauss

¹²Department of Gynecology, University Hospital Halle, Halle, Germany

,

Klaus Baumann

¹³Department of Gynecology, Medical Center Ludwigshafen, Ludwigshafen, Germany

,

Matthias Beckmann

¹⁴Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany

,

Alexander Mustea

¹⁵Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, Bonn, Germany

,

Werner Meier

¹⁶Department of Obstetrics and Gynecology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany

,

Pauline Wimberger

¹⁷Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany

,

Lars Hanker

¹⁸Department of Gynecology and Gynecologic Oncology, University Medical Center Lübeck, Lübeck, Germany

,

Ulrich Canzler

¹⁷Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany

,

Tanja Fehm

¹⁹Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany

,

Alexander Luyten

²⁰Department of Gynecology and Obstetrics, Medical Center Wolfsburg, Wolfsburg, Germany

,

Martin Hellriegel

²¹Department of Gynecology and Gynecologic Oncology, University Medical Center Göttingen, Göttingen, Germany

,

Jens Kosse

²²Department of Gynecology and Obstetrics, Sana Klinikum Offenbach, Offenbach, Germany

,

Christoph Heiss

²³Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert, Göppingen, Germany

,

Peer Hantschmann

²⁴Department of Gynecology and Obstetrics, Medical Center Altötting, Altötting, Germany

,

Peter Mallmann

²⁵Department of Gynecology and Gynecologic Oncology, University Medical Center Köln, Köln, Germany

,

Berno Tanner

²⁶Department of Gynecology and Obstetrics, Medical Center Oranienburg, Oranienburg, Germany

,

Jacobus Pfisterer

²⁷Gynecologic Oncology Center Kiel, Kiel, Germany

,

Sven Mahner

⁵Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany

,

Barbara Schmalfeldt

¹Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Anna Jaeger

¹Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

› Author Affiliations

Abstract

Zusammenfassung

Seit der Veröffentlichung der aktualisierten deutschen Leitlinie 2015 hat sich die Empfehlung zur pelvinen Lymphonodektomie (LNE) bei Patientinnen mit Vulvakarzinom (VSCC) grundlegend verändert – die Durchführung eines operativen Lymphknoten-Stagings wird darin bei allen Patientinnen mit erhöhtem Risiko für eine pelvine Lymphknotenbeteiligung empfohlen. Allerdings ist die Risikopopulation anhand der aktuellen Datenlage unscharf definiert und daher die Indikation zum Eingriff in der Praxis weiterhin unklar. Um sowohl den prognostischen Einfluss einer histologisch gesicherten pelvinen Lymphknotenmetastasierung als auch den Zusammenhang zwischen inguinaler und pelviner Lymphknotenbeteiligung zu beleuchten, stehen aktuell 2 deutsche Kollektive von Patientinnen mit pelviner LNE zur Verfügung: in der multizentrischen AGO-CaRE-1-Studie wurden insgesamt 1618 Patientinnen mit primärem VSCC FIGO-Stadium ≥ IB (1998 – 2008) dokumentiert, davon erhielten 70 eine pelvine LNE; im Zuge einer retrospektiven monozentrischen Auswertung am UKE wurden von 1996 – 2018 insgesamt 514 Patientinnen mit primärem VSCC ausgewertet, hiervon 21 mit pelviner LNE. In beiden Kollektiven waren ca. 80% der Patientinnen mit durchgeführter pelviner LNE inguinal nodal positiv mit einer medianen Anzahl von 3 betroffenen Leistenlymphknoten. Pelvine Lymphknotenmetastasen ohne inguinale Lymphknotenmetastasen wurde in beiden Kollektiven nicht beobachtet. Zwischen 33 – 35% der inguinal nodal positiven Patientinnen waren pelvin ebenfalls nodal positiv, bei diesen war die mediane Anzahl betroffener Leistenlymphknoten hoch mit > 4 und einem medianen Maximaldurchmesser der größten inguinalen Metastase von > 40 mm in beiden Kohorten. Für die Mehrheit nodal positiver Patientinnen mit VSCC ist damit vermutlich weder ein pelvines Lymphknoten-Staging noch eine pelvine Radiotherapie notwendig, da ein relevantes Risiko für eine pelvine Lymphknotenbeteiligung vor allem in hochgradig nodal positiven Fällen besteht. Für eine valide Vorhersage des Zusammenhangs zwischen inguinaler und pelviner Lymphknotenbeteiligung bedarf es weiterführender prospektiver Datenerhebungen.

Schlüsselwörter

Vulvakarzinom - Lymphknotenmetastasen - pelvine Lymphonodektomie - Rezidiv - Prognose

Full Text

References

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