Prognostic impact of pathological resection margin distance in primary squamous cell carcinoma of the vulva

Background:

A tumor-free resection margin is considered state-of-the art in the operative treatment of primary vulvar cancer. The optimal width of tumor-free margins is still under discussion and published studies are inconsistant. The aim of this study was to investigate the impact of pathological resection margin distance for locoregional control and recurrence-free survival in a large cohort of patients.

Methods:

Patients surgically treated for primary squamous carcinoma of the vulva at the Tuebingen University Women's Hospital between 2004 – 2016 were identified. Minimal margin distances were pathologically determined in all dimensions after fixation. Cases were divided into subgroups with margin distances < 1 mm, 1 – 3 mm, 3 – 8 mm and > 8 mm.

Results:

287 patients were identified, of which 80 had pT1a, 140 pT1b, 55 pT2, 11 pT3 and 1 pT4 tumors. Median age was 64,4 years. Median margin distance was 3,5 mm (< 1 mm: n = 120; 1 – 3 mm: n = 36; 3 – 8 mm: n = 73; > 8 mm: n = 58). After a median follow-up time of 3,2 years 93 cases recurred. Recurrence rates were 40% in patients with a margin distance of < 1 mm, 25% with 1 – 3 mm, 30% with 3 – 8 mm and 24.1% with > 8 mm. A statistically significant impact was found between cases with < 1 – 8 mm and > 8 mm (34,5% vs. 24,1%, p = 0.009). No significant association was found for overall survival (p = 0,433).

Conclusion:

In our patient cohort pathological resection margin distance was found to be a significant prognosticator for disease recurrence in vulvar cancer. So far no impact on overall survival of the patient could be shown. Currently clinical follow-up is being updated with final analyses to follow.