{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:29:41Z","timestamp":1786418981484,"version":"build-2736575974"},"reference-count":63,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Vulvar cancer is a rare malignancy, accounting for 5%\u20138% of gynecological cancers, most commonly vulvar squamous cell carcinoma (VSCC). Achieving adequate tumor\u2010free margins is crucial for local control. Although current guidelines recommend margins of at least 8\u2009mm, the optimal cut\u2010off remains uncertain, as published evidence is inconsistent. Other clinicopathological factors may also influence recurrence, but data are limited given the rarity of VSCC. This meta\u2010analysis aimed to evaluate the effect of margin width and additional prognostic factors on recurrence risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a PRISMA\u2010compliant systematic review and meta\u2010analysis, registered in PROSPERO (CRD420251135659). PubMed, Scopus, and Cochrane were searched through September 2025 for surgical VSCC studies reporting tumor\u2010free margin width and local recurrence. Pooled risk ratio (RR) and hazard ratio (HR) were estimated using random\u2010effects models, with subgroup analyses and risk of bias assessed using ROBINS\u2010I.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010eight cohort studies were included. Margins &lt;\u20098\u2009mm were associated with increased local recurrence (LR) (RR 1.42; 24.8% vs. 15.6% for \u2265\u20098\u2009mm). No significant difference was found between 3\u20138\u2009mm and &lt;\u20093\u2009mm, though recurrence was higher with &lt;\u20093\u2009mm. Margin width was not associated with regional or distant metastasis. Among patients with &lt;\u20098\u2009mm margins, adjuvant treatment were radiotherapy (22.5%) and re\u2010excision (12.5%). Predictors of LR included tumor size (HR 1.53), lateral site (HR 1.60), depth of invasion (HR 2.51), lymph node positivity (HR 2.52), and higher FIGO stage (HR 1.77).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tumor\u2010free margins \u2265\u20098\u2009mm are associated with a lower risk of local recurrence in VSCC. However, recurrence remains multifactorial, influenced by tumor size, depth of invasion, nodal involvement, and stage. Therefore, optimal management should combine adequate surgical margins with individualized adjuvant therapy tailored to the patient's risk profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO (CRD420251135659)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72110","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T02:39:25Z","timestamp":1785119965000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Recurrence in Vulvar Squamous Cell Carcinoma: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4733-8821","authenticated-orcid":false,"given":"Candra Novi Ricardo","family":"Sibarani","sequence":"first","affiliation":[{"name":"Division of 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