Impact of disease stage, treatment timing, and demographic disparities on survival in vulvar squamous cell carcinoma: Insights from a Surveillance, Epidemiology, and End Results-based analysis
Vulvar squamous cell carcinoma (VSCC) is a rare gynecologic malignancy with understudied survival outcomes. This study leverages Surveillance, Epidemiology, and End Results data to refine prognostic understanding and inform clinical decision-making. To assess overall survival (OS) in VSCC based on disease stage, treatment sequencing, timing, and demographic factors. This retrospective Surveillance, Epidemiology, and End Results study analyzed 15,055 VSCC patients (2000-2021). OS was evaluated using Kaplan-Meier analyses, stratified by disease stage, treatment modality, and timing. Socioeconomic factors, including race, income, and geographic location, were assessed for survival disparities. Patients with regional or distant metastasis had significantly worse OS compared to those with localized disease. In regional metastasis, surgery alone was associated with the best survival, with no additional benefit observed from radiation sequencing. In distant metastasis, surgery with radiation was associated with the best outcomes, and all treatment groups showed improved OS compared to no treatment. Early treatment (<30 days) improved OS, whereas delays beyond this were associated with worse outcomes. Survival disparities were observed by geography, income, and race. Optimizing treatment sequencing, ensuring timely intervention, and addressing disparities are critical to improving VSCC outcomes. Limitations include the retrospective nature of Surveillance, Epidemiology, and End Results data and lack of information on comorbidities, HPV status, and chemotherapy use.