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Abstract
Introduction/Background Primary tumor site has been increasingly proposed as an important prognostic factor in various malignant tumors, with limited data in vulvar cancer. This study aimed to investigate the association of primary tumor site with prognosis in vulvar cancer, stratified by vulvar squamous cell carcinoma (SCC) and non-SCC histological types.
Methodology This population-based retrospective study enrolled patients with vulvar cancer from the Surveillance, Epidemiology, and End Results (SEER) database between January 2000 and December 2018. The primary outcome was cancer-specific survival (CSS). The prognostic difference between labium majus, labium minus and clitoris groups was investigated using Kaplan-Meier analysis and Cox proportional hazards regression analyses.
Results A total of 3465 eligible patients with vulvar cancer were included with a mean age of 54.5 years. Among the 1076 (31.1%) patients with non-SCC, the multivariate Cox regression analyses showed that labium minus-sited disease (hazard ratio [HR] 1.85, 95% confidence interval [CI]: 1.27–2.71; P=0.001) and clitoris-sited disease (HR 2.37, 95% CI: 1.47–3.85; P<0.001) were significantly associated with worse CSS, compared with labium majus-sited disease. However, among the 2389 (68.9%) patients with SCC, no significant association of primary tumor site with CSS was found (P>0.05). Kaplan-Meier analyses also showed that the primary tumor site had a significant prognostic effect in vulvar non-SCC (P<0.001) but not in vulvar SCC (P=0.330).
Conclusion Among vulvar non-SCC, patients with labium minus-sited disease had a significantly worse prognosis than those with labium majus-sited disease, and a significantly better prognosis than those with clitoris-sited disease. Gynecologic oncologists should consider the prognostic effect of primary tumor site in vulvar non-SCC, and make optimal, personalized treatment and surveillance strategies based on different primary tumor sites.
Disclosures The authors declare no conflict of interest.
