Role of tumour-free margin distance for loco-regional control in vulvar cancer-a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study

Woelber L, Griebel LF, Eulenburg C, Sehouli J, Jueckstock J, Hilpert F, De Gregorio N, Hasenburg A, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann KH, Thiel F, Mustea A, Meier W, Harter P, Wimberger P, Hanker LC, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Richter B, Neuser P, Mahner S (2016)

Publication Type: Journal article

Publication year: 2016

Journal

Book Volume: 69

Pages Range: 180-188

DOI: 10.1016/j.ejca.2016.09.038

Abstract

AIM OF THE STUDY: A tumour-free pathological resection margin of ≥8 mm is considered state-of-the-art. Available evidence is based on heterogeneous cohorts. This study was designed to clarify the relevance of the resection margin for loco-regional control in vulvar cancer. METHODS: AGO-CaRE-1 is a large retrospective study. Patients (n = 1618) with vulvar cancer ≥ FIGO stage IB treated at 29 German gynecologic-cancer-centres 1998-2008 were included. This subgroup analysis focuses on solely surgically treated node-negative patients with complete tumour resection (n = 289). RESULTS: Of the 289 analysed patients, 141 (48.8%) had pT1b, 140 (48.4%) pT2 and 8 (2.8%) pT3 tumours. One hundred twenty-five (43.3%) underwent complete vulvectomy, 127 (43.9%) partial vulvectomy and 37 (12.8%) radical local excision. The median minimal resection margin was 5 mm (1 mm-33 mm); all patients received groin staging, in 86.5% with full dissection. Median follow-up was 35.1 months. 46 (15.9%) patients developed recurrence, thereof 34 (11.8%) at the vulva, after a median of 18.3 months. Vulvar recurrence rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin ≥8 mm. When analysed as a continuous variable, the margin distance had no statistically significant impact on local recurrence (HR per mm increase: 0.930, 95% CI: 0.849-1.020; p = 0.125). Multivariate analyses did also not reveal a significant association between the margin and local recurrence neither when analysed as continuous variable nor categorically based on the 8 mm cutoff. Results were consistent when looking at disease-free-survival and time-to-recurrence at any site (HR per mm increase: 0.949, 95% CI: 0.864-1.041; p = 0.267). CONCLUSIONS: The need for a minimal margin of 8 mm could not be confirmed in the large and homogeneous node-negative cohort of the AGO-CaRE database.

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Involved external institutions

Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Oberhavel Klinik Oranienburg Germany (DE) Georg-August-Universität Göttingen Germany (DE) Otto-von-Guericke-Universität Magdeburg Germany (DE) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE) Universitätsklinikum Düsseldorf Germany (DE) Klinikum Wolfsburg Germany (DE) Universitätsklinikum Köln Germany (DE) Alb Fils Kliniken Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Philipps-Universität Marburg Germany (DE) Evangelisches Krankenhaus Düsseldorf Germany (DE) Universitätsklinikum Freiburg Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Kreiskliniken Altötting-Burghausen Germany (DE) Technische Universität Dresden Germany (DE) Universitätsmedizin Greifswald / Universitätsklinikum Greifswald Germany (DE) Sana Klinikum Offenbach Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Koordinierungszentrum für Klinische Studien der Philipps-Universität Marburg Germany (DE) Elblandkliniken Germany (DE) Kliniken Essen-Mitte Germany (DE) Universität Ulm Germany (DE)

How to cite

APA:

Woelber, L., Griebel, L.-F., Eulenburg, C., Sehouli, J., Jueckstock, J., Hilpert, F.,... Mahner, S. (2016). Role of tumour-free margin distance for loco-regional control in vulvar cancer-a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study. European Journal of Cancer, 69, 180-188. https://dx.doi.org/10.1016/j.ejca.2016.09.038

MLA:

Woelber, Linn, et al. "Role of tumour-free margin distance for loco-regional control in vulvar cancer-a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study." European Journal of Cancer 69 (2016): 180-188.

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