Defining and quantifying histopathologic risk factors for regional and distant metastases in a large cohort of vulvar squamous cell carcinomas

Shayan Cheraghlou; Nicole A Doudican; Maressa C Criscito; Mary L Stevenson; John A Carucci

doi:10.1016/j.jaad.2023.03.049

Defining and quantifying histopathologic risk factors for regional and distant metastases in a large cohort of vulvar squamous cell carcinomas

J Am Acad Dermatol. 2023 Nov;89(5):1022-1030. doi: 10.1016/j.jaad.2023.03.049. Epub 2023 Apr 11.

Authors

Shayan Cheraghlou¹, Nicole A Doudican¹, Maressa C Criscito¹, Mary L Stevenson¹, John A Carucci²

Affiliations

¹ Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
² Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York. Electronic address: john.carucci@nyulangone.org.

PMID: 37054818
DOI: 10.1016/j.jaad.2023.03.049

Abstract

Background: Vulvar squamous cell carcinoma (vSCC) is a rare tumor with a good prognosis when treated at a localized stage. However, once regional/distant metastasis occurs, vSCC can be rapidly fatal. Thus, it is important to identify tumor prognostic features so that high-risk cases can be prioritized for further diagnostic workup and treatment.

Objective: To estimate the risk of regional/distant metastasis at presentation and sentinel lymph node status for vSCC based on histopathologic characteristics.

Methods: A retrospective cohort study of 15,188 adult vSCC cases from the National Cancer Database diagnosed from 2012 to 2019.

Results: We provide specific estimates of the risk of clinically positive nodes and metastatic disease at presentation and sentinel lymph node positivity according to tumor size, moderate/poor tumor differentiation, and lymph-vascular invasion. These histopathologic factors were all significantly associated with the tested clinical outcomes in a multivariable analysis. Moderate (hazard ratio, 1.190; P < .001) and poor differentiation (hazard ratio, 1.204; P < .001) and lymph-vascular invasion (hazard ratio, 1.465; P < .001) were also associated with significantly poorer overall survival.

Limitations: Data on disease-specific survival not available in the data set.

Conclusions: We demonstrate the association of the histopathologic characteristics of vSCC with clinically important outcomes. These data may provide individualized information when discussing diagnostic/treatment recommendations, particularly regarding sentinel lymph node biopsy. These data may also guide future staging and risk stratification efforts for vSCC.

Keywords: NCDB; cutaneous; histopathologic; risk factors; sentinel lymph node biopsy; squamous cell carcinoma; vulvar.