Prognostic parameters were studied in 66 patients with invasive squamous cell vulvar cancer treated with radical vulvectomy and bilateral inguinal and femoral lymph node dissection. Patients with metastases in regional lymph nodes had a 46% survival for 3 or more years compared to 76.3% in patients without evidence of nodal spread. The presence of lymph nodal metastases correlated directly with stage, lesion size, depth of invasion, and the presence of lymph-vascular space involvement with tumor. However, even the best prognostic groups had a 30% incidence of positive nodes. No patient with less than 5 mm of stromal invasion without vascular involvement had positive nodes. These preliminary data suggest that careful observation of vascular space invasion by tumor cells together with measurement of the depth of stromal invasion may help define a group of patients with vulvar cancer that can be treated conservatively. Further studies are needed to confirm these findings in larger numbers of patients.
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