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Original research
Impact of partnership status on clinical outcomes of patients with vulvar squamous cell carcinoma and performance of sentinel lymph node biopsy
  1. Albert Alhatem1,
  2. W. Clark Lambert1,2,
  3. Katrice Karanfilian3,
  4. Sara Behbahani3 and
  5. Debra Heller1,4
  1. 1Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  2. 2Department of Dermatology, University Hospital, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  3. 3Rutgers New Jeresy Medical School, Newark, NJ, USA
  4. 4Department of Obstetrics, Gynecology & Women’s Health, University Hospital, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr Albert Alhatem, Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ 07101, USA; albert.alhatem{at}rutgers.edu

Abstract

Objectives Vulvar squamous cell carcinoma is a rare malignancy and lymph node involvement is the most significant prognostic factor. We aimed to evaluate the association between partnership status and mortality from vulvar squamous cell carcinoma, cancer stage at the time of presentation, and the decision for sentinel lymph node biopsy.

Methods The US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database was queried and different parameters were evaluated relative to partnership status. A total of 4851 patients with vulvar squamous cell carcinoma, >18 years of age, who presented between January 2010 to December 2015, were analyzed. Kaplan-Meier and Cox regression analyses were used to assess survival and hazard ratio. Multinomial regression analysis and χ2 were utilized to evaluate odd ratios and significance of variables.

Results Most patients were unpartnered (58.5%), including never married (17.7%), divorced (13.8%), or widowed (27%). Partnered patients were mostly Caucasian (88.4%), insured (74%), and presented with stage I disease (57.2%), compared with unpartnered patients (79.1%), (61.7%), and (51.7%), respectively (p<0.01). The mean survival time (months) in partnered patients was longer, compared with unpartnered (p<0.001), and the difference between both groups increased from 9 months at stage I to 24 months at stage IV, which remained independently significant after adjusting the different variables. Cox regression showed that partnered patients had a lower hazard ratio than unpartnered patients (p<0.01). Mortality from vulvar squamous cell carcinoma increased with age at diagnosis, no surgery, and unemployment (p<0.01). Unpartnered patients were the least likely to undergo sentinel lymph node biopsy in early stages, compared with partnered (p<0.01). Univariate Cox regression analysis showed that not performing sentinel lymph node biopsy almost doubled the hazard ratio of vulvar squamous cell carcinoma (p<0.01).

Conclusions Partnership status should be considered when counseling patients for vulvar squamous cell carcinoma therapy and when recommending screening and follow-up to optimize patient care.

  • vulvar and vaginal cancer
  • sentinel lymph node
  • carcinoma

https://doi.org/10.1136/ijgc-2019-001001

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    Footnotes

    • Twitter @AAlhatem_MD

    • Contributors AA: Project idea, design, data collection, statistical analysis, data interpretation, manuscript drafting, revision; WCL: Project design, data interpretation, manuscript revision; KK: Data collection, statistical analysis, data interpretation, manuscript editing, revision; SB: statistical analysis, data interpretation, manuscript editing, revision; DH: Project design, data interpretation, study supervision, critical manuscript revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.