Evaluation of treatment, prognostic factors, and survival in 198 vulvar melanoma patients: Implications for clinical practice

Florine L. Boer*, Mieke L.G. ten Eikelder, Nan van Geloven, Ellen H. Kapiteijn, Katja N. Gaarenstroom, Geoff Hughes, Linda S. Nooij, Marta Jozwiak, Ming Y. Tjiong, Joanne M.A. de Hullu, Khadra Galaal, Mariette I.E. van Poelgeest

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective: To identify clinicopathological characteristics, treatment patterns, clinical outcomes and prognostic factors in patients with vulvar melanoma (VM). Materials & methods: This retrospective multicentre cohort study included 198 women with VM treated in eight cancer centres in the Netherlands and UK between 1990 and 2017. Clinicopathological features, treatment, recurrence, and survival data were collected. Overall and recurrence-free survival was estimated with the Kaplan-Meier method. Prognostic parameters were identified with multivariable Cox regression analysis. Results: The majority of patients (75.8%) had localized disease at diagnosis. VM was significantly associated with high-risk clinicopathological features, including age, tumour thickness, ulceration, positive resection margins and involved lymph nodes. Overall survival was 48% (95% CI 40–56%) and 31% (95% CI 23–39%) after 2 and 5 years respectively and did not improve in patients diagnosed after 2010 compared to patients diagnosed between 1990 and 2009. Recurrence occurred in 66.7% of patients, of which two-third was non-local. In multivariable analysis, age and tumour size were independent prognostic factors for worse survival. Prognostic factors for recurrence were tumour size and tumour type. Only the minority of patients were treated with immuno- or targeted therapy. Conclusion: Our results show that even clinically early-stage VM is an aggressive disease associated with poor clinical outcome due to distant metastases. Further investigation into the genomic landscape and the immune microenvironment in VM may pave the way to novel therapies to improve clinical outcomes in these aggressive tumours. Clinical trials with immunotherapy or targeted therapy in patients with high-risk, advanced or metastatic disease are highly needed.

Original languageEnglish
Pages (from-to)202-210
Number of pages9
JournalGynecologic Oncology
Volume161
Issue number1
DOIs
Publication statusPublished - 1 Apr 2021

Bibliographical note

Acknowledgements:
We would like to thank Raj Naik and Ann Fisher, gynaeco-oncologists, and Wendy Mc Cormick and Lorraine Pearce, research nurses, for providing data from the Queen Elizabeth Hospital, NHS trust in Gateshead.

Publisher Copyright: © 2021 The Authors

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