Prognostic value of the number and laterality of metastatic inguinal lymph nodes in vulvar cancer: revisiting the FIGO staging system.

OBJECTIVE: Inguinal lymph node (LN) metastasis is an important prognostic factor in vulvar cancer. Our aims were to analyze the prognostic value of LN metastasis with regard to the number of LNs that were involved and their laterality and compare these results with the current FIGO staging system. METHODS: A retrospective analysis was performed in a series of 234 individuals who underwent inguinal lymphadenectomy for vulvar squamous cell carcinoma from January 1980 to February 2010. RESULTS: The mean age was 68 years. One hundred seven (45.7%) patients had LN metastasis. Despite the FIGO staging, we did not observe any significant difference in the risk of recurrence or death between patients with 1 positive LN and ≥ 2 positive LNs. Moreover, there was no difference in outcome between the presence of 1 and 2 positive LNs. On categorizing patients into 3 groups-absence of LN involvement, 1-2 positive LNs, and ≥ 3 positive LNs-we achieved a significantly better prognostic correlation for progression-free survival, disease-specific survival, and overall survival. Extracapsular spread retained a prognostic role for the risk of recurrence in multivariate analysis. Further, for patients with ≥ 2 positive LNs, the presence of bilateral positive LNs did not negatively impact the risk of recurrence or death compared with those with unilateral positive LNs. CONCLUSIONS: Our data suggest that the prognostic effect of bilateral LNs reflects the worse prognosis of multiple positive LNs. Regarding prognosis, LN involvement should be categorized into 2 groups-1-2 positive LNs and ≥ 3 positive LNs.

Does the count after inguinofemoral lymphadenectomy in vulvar cancer correlate with outcome?

BACKGROUND: Inguinal lymph node (LN) metastasis is an important prognostic factor in vulvar cancer. Our aim was to determine the prognostic value of the number of resected LNs in inguinofemoral lymphadenectomy. METHODS: A retrospective analysis was performed in a series of 158 individuals who underwent bilateral inguinofemoral lymphadenectomy for vulvar squamous cell carcinoma from January 1980 to February 2010. RESULTS: The mean age was 67 years (range: 15-90). Median tumor size was 5 cm (range: 1-18). A median of 22.5 inguinal LNs (range: 2-57) was resected. Thirteen (8.2%) patients had <12 LNs resected, and 145 (91.8%) had ≥ 12 LNs resected. Eighty (50.6%) patients had LN metastasis, with a median of 2 positive LNs (range: 1-16). Of those with positive LNs, 19 (23.8%), 23 (28.8%), and 38 (47.5%) patients had 1, 2, and 3 or more positive LNs, respectively. Thirty-three (41.2%) patients had bilateral LN metastasis. For patients without LN involvement, we failed to observe any significant difference between patients with <12 LNs and ≥ 12 LNs that were resected with regard to risk of recurrence (p=0.97) and death from cancer (p=0.43) in 5 years. However, resection of <12 LNs in patients with positive LNs negatively impacted the risk of recurrence (p=0.003) and death from cancer (p=0.043). CONCLUSIONS: Resection of fewer than 12 LNs in vulvar cancer has a negative impact on outcome for patients with positive inguinal LNs.

Superficial cemental curettage: its efficacy in promoting improved cellular attachment on human root surfaces previously damaged by periodontitis.

This study was designed primarily to determine whether or not gingival fibroblasts attach to curetted cemental surfaces in periodontally-involved human teeth. Ten periodontally-involved human teeth were used. The superficial cementum from 5 teeth was removed by light mechanical curettage while no root treatment was performed on the remaining 5 teeth. Subsequently, the roots of all teeth were cut longitudinally to create 800 microns thick sections (slabs). Prepared slabs were then placed in 35 mm culture dishes, seeded with human gingival fibroblasts (HGF), and after 4 weeks processed for transmission electron microscopy (TEM). TEM results revealed flattened HGF on the noncuretted cemental surfaces that failed to attach. Fibrillar material was not seen between the HGF and cemental surfaces. In contrast, the HGF that grew on previously curetted cementum exhibited typical morphology of healthy, functional fibroblasts. Newly synthesized fibrillar material and collagen fibrils were noted, and both were apparently oriented towards the curetted cemental surface. Results strongly suggest that improved cellular attachment can be promoted on areas of root surface previously damaged by periodontitis if superficial cementum is first removed by mechanical curettage.

An ultrastructural study comparing new gingival tissue attachment on chemically exposed fibrils and retained periodontal ligament.

Successful periodontal healing has been demonstrated in animals following application of citric acid to exposed root surface. However, we have been unable to achieve comparable results on clinical patients. Accordingly, the present study, using monkeys, was designed to re-evaluate the degree of interdigitation of newly-formed gingival fibrils with ones exposed to citric acid compared to normal attachment tissues of the retained periodontal ligament. We found that superficial collagen fibrils in both cases suffer degradation following normal inflammation and healing secondary to flap surgery. On retained periodontal ligament tissues, this change was limited to superficial levels and newly-formed collagen fibrils were linked immediately with old ones. In contrast, when exposed collagen fibrils were conditioned by exposure to citric acid, the degradative change occurred more deeply, and healing was delayed. Thus, the citric acid may not be the best choice of root treatments in terms of promoting better gingival tissue attachment. Furthermore, the results indicated that fibrils preserved on the root should not be curetted as possible during flap surgery as they offer an improved chance for optimal reattachment.