Outcomes of patients with metastatic squamous cell carcinoma of the vulva
This study aimed to investigate the management and outcomes of patients with stage IVB squamous cell carcinoma of the vulva. Patients diagnosed between 2004 and 2015 with squamous cell carcinoma of the vulva and distant metastases were identified in the National Cancer Database. The median overall survival was evaluated with Kaplan-Meier curves, and a univariate analysis was performed with the log-rank test. Cox models were constructed to control for patient age and presence of co-morbidities. A total of 710 patients were identified; 338 (47.6%) had metastases to distant lymph nodes only, whereas 310 (43.7%) had metastases to other distant sites and 62 had stage IVB not specified. Patients with distant lymph node involvement only had better prognosis than those with other distant metastases (median overall survival was 13.4 vs 6.01 months, respectively, p < .001). For patients with distant lymph node metastases, the combination of chemotherapy and radiation therapy (n = 213, median 17.84 months) was associated with better survival than radiation therapy alone (n = 56, median 7.39 months) (p < .001). For patients with other distant metastases, the combination of chemotherapy with radiation therapy (n = 126, median 8.6 months) was associated with better survival than radiation therapy alone (n = 65, median 5.49 months) (p < .001). There was no difference in the overall survival between single-agent and multi-agent chemotherapy for patients who did (median 7.98 vs 10.94 months, p = .73) and did not (median 13.4 vs 16.2 months, p = .30) receive radiation therapy. Stage IVB vulvar carcinoma has a poor prognosis. Patients with distant lymph node involvement have a better prognosis than those with other distant metastases, especially when multi-modal treatment is used. The efficacy of multi-agent chemotherapy appears to be limited.