Prognostic role of inguinal lymphadenectomy in vulvar squamous carcinoma: Younger and older patients should be equally treated. A prospective study and literature review

Objective This study analyzed the prognostic significance of nodal involvement in vulvar squamous carcinoma and its correlation with other prognostic factors, focusing the research on comparison between <75 and 75 years old patients. Methods We prospectively enrolled patients with > 1-mm-deep stromal invasion, Ib-III stage vulvar cancer. Patients underwent unilateral or bilateral inguinal lymphadenectomy, according to tumor localization. Results In total, 131 patients met inclusion criteria; 93 (71%) underwent bilateral and 38 (29%) unilateral lymphadenectomy with 36 (27%) of them presenting nodal disease. At Kaplan-Meier analysis factors associated to prognosis were nodal status (in very elderly patients also) and number of resected nodes both in bilateral and unilateral lymphadenectomy groups. In univariate analysis, covariates associated with survival included age, in terms of overall survival (OS) but not with disease free-survival (DFS) and disease-specific survival (DSS), grading, nodal status, the presence of bilateral nodal metastases, the number of resected nodes in both unilateral, in terms of OS and DSS but not of DFS and bilateral lymphadenectomy and the number of metastatic nodes. In multivariate analysis covariates associated with survival were age, the number of positive nodes and the number of resected nodes in bilateral lymphadenectomy. Conclusions Results confirm the prognostic role of nodal status in very elderly patients also. Although DSS in older patients resulted worse, lymphadenectomy is not associated with more complications, suggesting its importance in older patients too. Furthermore, the resection of less than 15 lymph nodes in bilateral lymphadenectomy seems to have a negative impact on survival.