Evaluation of prognostic indicators in squamous carcinoma of the vulva including nuclear DNA content.

The prognostic value of clinical and pathologic features including tumor ploidy status was evaluated in 43 randomly selected primary invasive squamous carcinomas of the vulva in which the lesion was totally excised and a lymph node dissection performed. By both univariate and multivariate analysis, survival most closely correlated with the number of involved lymph nodes. In the subgroup of patients with negative lymph node dissections, outcome was also found to correlate with tumor diameter but not with any other feature studied including nuclear DNA content. Both the FIGO surgical staging system and stratification of patients by Gynecologic Oncology Group (GOG) risk groups provided valuable methods of estimating prognosis with survival rates of 100%, 80%, 59%, and 25% for FIGO stages I, II, III, and IV, respectively, and rates of 100%, 75%, 56%, and 42% for GOG groups of minimal, low, intermediate, and high risk. Subdivision of patients with FIGO Stage III disease based on tumor diameter and the number of involved lymph nodes appeared to be of prognostic value with a survival rate of 67% when tumor diameter was below 8 cm and less than three lymph nodes were involved but only 50% when either value was above the cut-off point. This study suggests that DNA ploidy status is not a prognostic value in vulvar squamous carcinoma, but the results support the value of utilizing the number of involved lymph nodes for prognosis assessment. The latter feature in combination with tumor size may be useful in the subdivision of FIGO Stage III patients into prognostic subgroups.