# Depth of Invasion of 13 mm or Greater Accurately Predicted the Risk of Having a Node Positivity in Lymphadenectomy for Squamous Vulvar Cancer

## TL;DR

A depth of tumor invasion of 13 mm or more is a strong predictor of lymph node involvement in squamous vulvar cancer patients.

## Contribution

A 13 mm depth of invasion cutoff was identified as an independent predictor of lymph node positivity with 78.4% accuracy.

## Key findings

- A depth of invasion of 13 mm or more increased the risk of node positivity 11 times.
- The 5-year overall survival rate was 8.6% in the node-positive group.
- Most events occurred within the first 24 months in the node-positive group.

## Abstract

To analyze factors related to lymph node involvement in patients with squamous vulvar cancer undergoing lymphadenectomy and wide local excision at the University Hospital in Campinas, Brazil.

A retrospective study involving 56 women treated between 2010 and 2022. The primary outcome was inguinal lymph node involvement (positive or negative). Clinical, operative, and pathologic variables were analyzed by appropriate tests. Kaplan–Meier curves were used to determine overall survival rate (OS). A receiver operating characteristic (ROC) curve was created to determine the optimal value of the depth of invasion for predicting node positivity.

Of the 56 women who underwent surgery, node involvement was positive in 18 (32.1%). Where node was positive, the tumors were over 5 cm in 22.2% (versus 2.7%, p = 0.035), had an depth of invasion equal to or deeper than 13 mm (13 mm+) in 62.5% (versus 14.3%, p < 0.001), lymphovascular invasion in 33.3% (versus 11.8%, p = 0.024), presented disease progression in 44.4% (versus 11.8%, p = 0.019), and death in 77.8% (versus 31.6%, p = 0.001). The 5‐year OS was 57.1% in the node‐negative and 8.6% in the node‐positive group, with most events occurring within the first 24 months. Depth of invasion 13 mm + increased the risk of node‐positivity 11 times (11.37;1.85–69.82), showing a predictive negative value of 83.3%, and accuracy of 78.4%.

The 13.0 mm cutoff for depth of invasion was independently associated with the risk of having a positive node, with an accuracy of 78.4%. The 5‐year OS was 8.6% in the node‐positive group, with most events within the first 24 months.