Risk Factors for Recurrence in Vulvar Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Pathology

Background:

• Vulvar cancer, primarily vulvar squamous cell carcinoma (VSCC), is a rare gynecologic malignancy.
• Adequate tumor-free surgical margins are critical for local control in VSCC.
• Current guidelines recommend ≥8mm margins, but optimal cut-offs and prognostic factors require further clarification due to inconsistent evidence.

Purpose of the Study:

• To evaluate the impact of surgical margin width on local recurrence risk in VSCC.
• To identify additional clinicopathological factors influencing recurrence in VSCC patients.
• To provide evidence for optimizing surgical management and adjuvant therapy decisions.

Main Methods:

• A PRISMA-compliant systematic review and meta-analysis of 28 cohort studies.
• Searched PubMed, Scopus, and Cochrane databases for VSCC studies reporting margin width and local recurrence.
• Estimated pooled risk ratios (RR) and hazard ratios (HR) using random-effects models, with subgroup analyses and risk of bias assessment.

Main Results:

• Margins <8mm were associated with increased local recurrence (RR 1.42; 24.8% vs. 15.6% for ≥8mm).
• No significant difference in recurrence was found between 3-8mm and <3mm margins, though <3mm showed higher recurrence.
• Predictors of local recurrence included larger tumor size, lateral site, deeper invasion, lymph node positivity, and higher FIGO stage.

Conclusions:

• Tumor-free margins of ≥8mm are associated with a lower risk of local recurrence in VSCC.
• Recurrence is multifactorial, influenced by tumor size, invasion depth, nodal status, and stage.
• Optimal VSCC management necessitates combining adequate surgical margins with individualized adjuvant therapy based on patient risk profiles.