Patterns of distant metastases in vulvar cancer

Background: While treatment of early stage vulvar cancer is standardized, little information is available regarding treatment of advanced, recurrent and especially metastatic disease. We therefore analyzed incidence and pattern of metastases in vulvar cancer in a large retrospective single center cohort.

Methods: All patients with primary squamous cell cancer of the vulvar (n = 391, median age: 60 years; range 20 – 94) treated at the Gynecologic Cancer Center Hamburg-Eppendorf between 1996 and 2013 were retrospectively evaluated for occurrence of distant metastasis. Pattern of metastatic spread, prognosis and therapeutic strategies were analyzed.

Results: Out of 391 patients with primary squamous cell vulvar cancer, 20 patients (5.1%) developed distant metastases. Median time to diagnosis of metastases was 13.5 months (range 4 – 104) after primary diagnosis. Most patients experienced one or more local recurrences before distant spread (12/20, 60%). Documented metastatic sites were lung (n = 9), liver (n = 7), bone (n = 5), lymph-nodes (axillary, thoracic, paraaortic, n = 3) and skin (n = 4). The majority of patients presented with unilocal metastases (n = 13). In univariate analysis tumor diameter, invasion depth, nodal status and number of metastatic lymph nodes were identified as predictive factors for the occurrence of distant metastases. Two-year overall survival rate of all metastatic patients was 12.5%, median survival from first diagnosis of metastases 5.6 months.

Conclusion: The occurrence of distant metastases from vulvar cancer is a rare event with limited prognosis. Further research efforts will be crucial to identify prognostic markers as well as therapeutic targets in order to improve survival in these patients.