Abstract
Pathologic resection margin status and risk of local recurrence in patients with apparent early-stage squamous cell carcinoma: Results from the International Vulvar Cancer Consortium
Gynecologic oncology, Vol.200(Suppl 1), pp.18-19
09/2025
DOI: 10.1016/j.ygyno.2025.03.075
Abstract
Objectives
This study aimed to investigate the impact of pathologic margin distance on the risk of local recurrence for patients with apparent early-stage vulvar cancer.
Methods
An international multicenter retrospective study across 25 institutions was conducted among patients with unifocal early-stage squamous cell carcinoma of the vulva with ≥1 mm depth of invasion, who underwent vulvectomy and inguinofemoral lymph node evaluation with known status of surgical margins and pathologic margin distance.
Results
A total of 524 patients with a median age of 69 years (range: 28–96) who met the inclusion criteria were included. The median tumor size was 2 cm, while the median depth of invasion was 4 mm and 25.8 % (n = 135) of patients had inguinal lymph node metastases. Based on the pathology report, all patients had negative tumor resection margins, while the median closest margin distance was 5 mm (range: 0.02–25 mm). The overall rate of local recurrence was 22.7 % (n = 119), with a median time to local recurrence of 19.3 months. For most patients (n = 92, 77.3 %), it was the only site of disease recurrence. Inguinal lymph node metastases (28.9 % vs 20.6 %, P = 0.047), presence of lichen sclerosus (33.8 % vs 20.6 %, P = 0.017) at the resection margin and larger tumor size (median 2.4 vs 2.0 cm, P = 0.03) were associated with a higher rate of local recurrence. Tumor grade (P = 0.68), presence of differentiated vulvar intraepithelial neoplasia or high-grade squamous intraepithelial lesion at the margin (P = 0.15), lymphovascular space invasion (LVSI) (P = 0.44), perineural invasion (P = 0.85) and depth of tumor invasion (P = 0.13) were not associated with a higher risk of local recurrence. By multivariable logistic regression, only presence of lichen sclerosus at the margin (OR 1.92, 95 % CI 1.08–3.41) was independently associated with higher odds of local recurrence while pathologic margin <8 mm (OR 1.07, 95 % CI 0.66–1.76), tumor size, depth of invasion, LVSI and presence of lymph node metastases were not. When excluding patients who underwent re-excision or received radiotherapy at the primary site (n = 95, 18.1 %), pathologic margin distance as a continuous variable was again not associated with local recurrence. The rate of local recurrence was comparable among patients with pathologic margins <2 mm (23.7 %), 2–3.9 mm (23.6 %), 4–7.9 mm (22.2 %) and ≥ 8 mm (22 %) (P = 0.99). Similarly, when using different cutoffs, pathologic margin distance was not associated with local recurrence; 8 mm (22 % vs 22.9 %, P = 0.84), 5 mm (22.7 % vs 22.4 %, P = 0.94), 4 mm (22.1 % vs 23.6 %, P = 0.71), 3 mm (22 % vs 24.7 %, P = 0.57) and 2 mm (22.4 % vs 23.7 %, P = 0.83). Lastly, for patients with pathologic margin distance ≤4 mm, there was no difference in local recurrence rate between those who had re-excision/radiation (n = 58, 25.9 %) and those who did not (n = 192, 22.4 %) (P = 0.58).
Conclusions
Close pathologic resection margins may not impact the risk of local recurrence for patients with early-stage vulvar cancer, while the presence of lichen sclerosus at the margin is a major risk factor.
Details
- Title: Subtitle
- Pathologic resection margin status and risk of local recurrence in patients with apparent early-stage squamous cell carcinoma: Results from the International Vulvar Cancer Consortium
- Creators
- Dimitrios NasioudisChristoph WohlmuthBenjamin AlbrightMegan McDonaldSumer WallaceAriel GlickmanAnthony DoGina Mantia-SmaldoneTommaso GrassiElaine FlemingIrina TsibulakRicardo Dos ReisGiuseppe CucinellaFernando HerediaAugusto PereiraGiorgio BoganiLindsey BuckinghamGlauco BaiocchiKathryn MillsMariam AlHilliAndreas ObermairAllan CovensAndrea MarianiMarie PlanteRobert Giuntoli
- Resource Type
- Abstract
- Publication Details
- Gynecologic oncology, Vol.200(Suppl 1), pp.18-19
- DOI
- 10.1016/j.ygyno.2025.03.075
- ISSN
- 0090-8258
- eISSN
- 1095-6859
- Publisher
- ACADEMIC PRESS INC ELSEVIER SCIENCE; SAN DIEGO
- Language
- English
- Date published
- 09/2025
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9984969242602771
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