Prognostic Factors and Recurrence Patterns of Vulvar Cancer

Abstract

Objective: Vulvar cancer is a rare disease among gynecological cancers, mostly affecting postmenopausal women. The associated prognostic factors are not clear enough and the results in the studies are inconclusive due to rarity. We aimed to determine the impact of clinicopathological and therapeutic prognostic factors on the course of treatment and the patient's survival. The characteristics of recurrences, anatomic localization, and treatment strategies are also described. Material and Methods: A total of 46 patients with clinicopathological diagnosis of squamous cell carcinoma of vulva who were treated at our tertiary care center between 2004 and 2021 were included in this retrospective cohort analysis study. Data on demographic, clinical and obstetric characteristics of patients at the time of initial diagnosis as well as tumor clinicopathologic features, treatment modalities, and oncological outcomes were recorded. Data were analyzed using Cox proportional hazards regression and Kaplan-Meier methods. Results: The overall recurrence rate was 34.7% (n=16). The average median overall survival (OS), 5-year OS rate and median 5-year OS was 172 months, 63.6% and 51.9 months, respectively. Five-year progression-free survival rate was 71.7%. Patients experiencing recurrence demonstrating a notably shorter survival duration compared to those without recurrence (p<0.05). On logistic regression analysis receiving radiotherapy and neutrophil value were important prognostic factors for recurrence. The risk of recurrence in those who received radiotherapy was found to be 15 times higher compared to those who did not receive radiotherapy (OR = 15.032). The chance of recurrence rises by 0.05% (OR = 1.0005) for every unit increase in the neutrophil value. Conclusion: Receiving radiotherapy is an important predictor of vulvar cancer recurrence.

Keywords

• Disease free survival
• Prognostic factors
• Recurrence
• Survival
• Vulvar cancer

Vulva Kanserinde Prognostik Faktörler ve Nüks Paternleri

Öz

Amaç: Vulva kanseri, jinekolojik kanserler arasında nadir görülen bir hastalık olup, çoğunlukla postmenopozal kadınları etkilemektedir. İlişkili prognostik faktörler yeterince net değildir ve çalışmalardaki sonuçlar, hastalığın nadir görülmesi nedeniyle kesinlik taşımamaktadır. Klinikopatolojik ve terapötik prognostik faktörlerin tedavi süreci ve hasta sağ kalımı üzerindeki etkisini belirlemeyi amaçladık. Nükslerin özellikleri, anatomik lokalizasyonu ve tedavi stratejileri de detaylandırılmıştır. Gereç ve Yöntemler: Bu retrospektif kohort analizine, 2004–2021 yılları arasında üçüncü basamak sağlık merkezimizde tedavi edilmiş ve klinikopatolojik olarak vulvar skuamöz hücreli karsinom tanısı almış toplam 46 hasta dahil edilmiştir. Hastaların ilk tanı anındaki demografik, klinik ve obstetrik özelliklerinin yanı sıra tümörün klinikopatolojik özellikleri, tedavi modaliteleri ve onkolojik sonuçlarına ilişkin veriler kaydedilmiştir. Veriler, Cox regresyon analizi ve Kaplan-Meier yöntemleri kullanılarak analiz edilmiştir. Bulgular: Genel nüks oranı %34,7 (n=16) olarak bulunmuştur. Ortalama medyan genel sağ kalım (OS), 5 yıllık OS oranı ve medyan 5 yıllık OS sırasıyla 172 ay, %63,6 ve 51,9 ay olarak hesaplanmıştır. Beş yıllık progresyonsuz sağ kalım oranı %71,7 olarak belirlenmiştir. Nüks olan hastalar, nüks olmayanlara kıyasla belirgin şekilde daha kısa bir sağ kalım süresine sahiptir (p<0,05). Lojistik regresyon analizine göre radyoterapi alımı ve nötrofil değeri, nüks için önemli prognostik faktörler olarak belirlenmiştir. Radyoterapi alan bireylerde nüks riskinin, radyoterapi almayanlara kıyasla 15 kat daha yüksek olduğu tespit edilmiştir (OR = 15,032). Nötrofil değerindeki her bir birimlik artış, nüks olasılığını %0,05 oranında artırmaktadır (OR = 1,0005). Sonuç: Radyoterapi alımı, vulva kanseri nüksü için önemli bir belirleyicidir.

Anahtar Kelimeler

• Hastalıksız sağkalım
• Prognostik faktörler
• Nüks
• Sağkalım
• Vulva kanseri

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