[Effectiveness of radical therapy in vulvar carcinoma. An analysis of 148 cases]

148 patients with primary squamous cell carcinoma of the vulva were treated by surgery at the N. N. Petrov-Cancer Research Institute St. Petersburg. There were 73 unilateral lesions confined to the labium majus or labium minus, 17 to labium majus and minus, 41 to the clitoris and 17 lesions to other structures. 28 patients had FIGO I lesion, 58 a FIGO II, and 62 patients had a FIGO III tumor. In 41 cases the depth of infiltration was 1-5 mm, in 83 cases 6-10 mm, and in 24 cases the depth of infiltration was greater than 11 mm. Radical vulvectomy with inguinal lymphadenectomy was performed in 115 cases, a simple vulvectomy in 33 cases (Nx). In 53 patients lymph nodes were positive and in 62 negative. The patients were followed for at least 60 month and none have been lost to follow-up. The stage dependent 5-year-survival rate was 96.4% (FIGO I), 87.7% (FIGO II), 62% (FIGO III), and 79.2% (overall). The 5-year-survival rate of lesions of the labium minus was 94.6%, of the labium majus was 83.1%, of the clitoris--82.2%. A poor prognosis was found in the cases of a tumor involvement in labium majus and minus and/or other vulvar structures (60% and 59.9%). Increasing depth of invasion was associated with decreasing 5-year-survival rate: 97.5% ($ 5 mm), 72.4% (6-10 mm) and 65.4% (> 11 mm). In patients with lymph node involvement the prognosis was significantly better than in those with negative lymph nodes (61.6% vs. 86%). On the other hand, the prognosis of patients with a solitary lymph node metastasis was significantly better than in patients with two or more lymph node metastasis (79.6% vs. 51.6%). Tumor localization, tumor size, lymph node status and especially the depth of invasion are the important prognostic factors in vulvar cancer.