Squamous Cell Carcinoma of the Vulva: A Survival and Epidemiologic Study with Focus on Surgery and Radiotherapy

Abstract

Vulvar squamous cell carcinoma (SCC) is the most frequent vulvar neoplasia. While the primary role of surgery is widely accepted, large population studies are needed to compare survival between diverse treatment modalities and to identify independent prognostic factors to help council patients and guide oncological treatment. The U.S. National Cancer Index, Surveillance, Epidemiology and End Results (SEER) program data between 2000 and 2018 was screened for all squamous cell carcinoma affecting the vulva. Raw data was processed with IBM SPSS. Demographic, clinical-pathological and treatment data were studied. Overall survival (OS) was calculated using the Kaplan–Meier method and subgroups were compared using the log rank test. A multivariate cox regression was conducted to identify independent prognostic factors. A total of 11,360 patients were identified with a median age of 65. Median overall survival was 101 months. Surgery as a primary treatment is the therapeutic sequence associated with the best overall survival. Multivariate cox-regression did not meet proportional hazard assumption. Age, pathological grade, stage at diagnosis, treatment sequence and the use of chemotherapy were identified as independent prognostic factor. Surgery alone is the treatment sequence offering the best overall survival. Surgery should be offered to all eligible patients.

Establishment and validation of a nomogram for estimating the overall survival of vulvar squamous cell carcinoma patients aged 50 years or older

“…We also observed that chemotherapy was associated with improved OS, which was concordant with Mao Y et al [14] and Vulcan et al [23]. However, Scampa et al [16] contrastingly observed that chemotherapy was not associated with OS benefits, possibly because it was mostly prescribed in patients with advanced diseases, thereby demonstrating lower survival rates.…”

“…Nomogram is a widely used graphical scoring model that combines various independent risk factors to predict the overall survival of cancer patients [10,11]. Presently, there are limited studies on nomograms for vulvar cancer [12][13][14][15][16] and none for elderly vulvar cancer patients. Considering that these patients are at high risk of developing complications and mortality, it is very important to identify prognostic factors that could affect their prognosis, accurately estimate their overall survival and develop individualized treatments that could improve their outcomes.…”

Based on the surveillance, epidemiology, and end results programme, to develop and validate nomograms for predicting overall survival and cancer-specific survival in geriatric patients with vulvar squamous cell carcinoma

“…Regarding chemotherapy, our results are consistent with the idea that it can significantly improve OS in vulvar cancer patients [31]. However, a study by Scampa et al [32] reported that the OS of patients benefiting from chemotherapy was statistically lower than those who did not benefit, possibly because chemotherapy is primarily administered to patients with advanced diseases, leading to shorter survival time.…”

“…VSCC. Specifically, older patients exhibited poorer survival rates, consistent with prior research [16,19,27,28]. Our study also confirms that both TNM and AJCC stages are significant predictors for OS and cancer-specific CSS in VSCC patients, aligning with their established roles in predicting patient survival [15].…”

“…Numerous tumor characteristics, including size, depth of invasion, local extension, nodal status and regional and distant spread, are evaluated for their correlation with overall survival (OS) [14]. However, an increasing number of research based on the SEER database suggests that patientrelated factors, such as age, race, marital status, pathological grade, utilization of radiotherapy, chemotherapy and surgical interventions, exert significant influence on prognosis [15][16][17][18][19]. The SEER program in the United States (US) operates as a population-based tumor registry, covering approximately 35% of the current US population and capturing 97% of reported cancer cases in the registry areas [20].…”