Polterauer S, et al. - Researchers used the AGO-CaRE-1 study multicenter database to confirm the role of lymph node ratio (LNR) in the evaluation of outcome in patients with vulvar cancer after surgery with inguinal lymphadenectomy. Using univariate and multivariable survival analyses, they evaluated the value of LNR for predicting overall (OS) and progression-free (PFS) survival. LNR was defined as ratio of number of positive lymph nodes (LN) to the number of resected. They identified 1047 patients treated with surgery including inguinal lymph node resection for squamous cell carcinoma of the vulva, with positive inguinal LN in 370 (35.3%). They noted 677 (64.7%) had a LNR of 0% (N0), 255 (24.4%) a LNR of >0% < 20%, and 115 (11%) a LNR of ≥20%. Findings in multivariable analyses revealed an association of LNR, FIGO stage, and patient's performance status, with PFS. LNR. For both PFS and OS, LNR appeared to be a consistent, independent prognostic parameter in women with vulvar cancer. Furthermore, it enabled patient stratification into three distinct risk groups. The performance of LNR was better than that of nodal status and number of positive nodes in survival analyses.