The impact of absent vulvar cancer screening guidelines on outcomes of vulvar squamous cell carcinoma: a national cancer database study
Abstract
Purpose
To analyze current vulvar squamous cell carcinoma (VSCC) data with respect to age groups and determine if gynecologic cancer screening guidelines address the burden of VSCC on the ≥ 65 cohort.
Methods
Patient data from 2004 to 2021 was identified from the National Cancer Database using ICD-10 codes specific for the vulva, and ICD-O-3 histology codes for squamous cell carcinoma or premalignant vulvar intraepithelial neoplasia Grade III. GraphPad Prism and IBM SPSS were used to analyze variable frequency with cross analysis. Chi-squared tests, Kaplan–Meier survival curves with log-rank comparison, and Cox proportional hazard regression models were utilized for statistical analysis. For regression models of hazard ratios (HRs) and odds ratios (ORs), the 50–64-year-old cohort was used as a reference variable.
Results
The patient population was 68,153. Mean overall survival decreased as age increased (≤ 49 years old was 184.9 months, 50–64 years old was 152.1 months, 65–74 years old was 107.3 months, and ≥ 75 years old was 57.7 months). The ≥ 75-year-old cohort had a 330% higher risk of mortality when compared to the reference variable (HR 4.3, p < 0.001), followed by the 65–74-year-old cohort (HR 1.96, p < 0.001). The ≥ 75 years old and 65–74-year-old cohorts had the highest likelihood of advanced VSCC (OR 1.91, p < 0.001 and OR 1.37, p < 0.001, respectively).
Conclusions
Patients ≥ 65 years old are significantly more likely to experience worse survival outcomes and higher stage diseases, indicating that a lack of screening protocols may influence VSCC outcomes.