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Survival disparities in vulvar cancer patients in Commission on Cancer®-accredited facilities.

Abstract：

OBJECTIVES:To investigate survival disparities and prognostic factors in vulvar cancer by age at diagnosis. METHODS:Women who underwent surgery and were diagnosed with stage I-IV vulvar cancer from 2004 to 2014 in the National Cancer Database were eligible. Proportions were compared using Chi-Square test. Survival was evaluated using Cox analysis. RESULTS:There were 18,207 eligible women. Median age at diagnosis was 64 years, and 31% diagnosed ≥75 years old were categorized as elderly. Most vulvar cancers were diagnosed at stage I and with squamous histology. Diagnosis with higher stage or non-squamous histology was more common in elderly vs. non-elderly patients (P < 0.001). Survival was 3.5 times worse in the elderly than the non-elderly (P < 0.0001). Risk of death for each 5-year increment in age increased by 22% for non-elderly and 43% for elderly patients (P < 0.0001). The prognostic value of comorbidity score, stage, regional node assessment and histology was smaller in elderly vs. non-elderly women (each P < 0.05). Adjuvant chemoradiotherapy (CTRT) use in the elderly vs. non-elderly was rare for stage I-II disease (3% vs. 2%) and more common for stage III-IV disease (6% vs. 43%), respectively (P < 0.0001). The survival disadvantage for elderly patients persisted following no adjuvant therapy, radiotherapy or chemotherapy alone, or CTRT (P < 0.0001). In stage III-IV disease, survival was superior following CTRT vs. radiotherapy when diagnosed <75 years (HR = 0.80, 95% CI = 0.69-0.93) but not in the elderly (HR = 0.99, P > 0.05). CONCLUSIONS:Age-associated risk of death increased at different rates in vulvar cancer and was larger in elderly vs. non-elderly patients. The impact of other prognostic factors was smaller in elderly vs. non-elderly women. The survival benefit of CTRT over radiotherapy in stage III-IV did not extend to the elderly.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

Gaulin NB,Lesnock JL,Tian C,Osei-Bonsu K,Jacobs A,Richard SD,Krivak TC,Miller EM,Shriver CD,Casablanca Y,Maxwell GL,Darcy KM

doi

10.1016/j.ygyno.2019.11.025

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

136-145

issue

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(19)31676-2

journal_volume

157

pub_type

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Survival disparities in vulvar cancer patients in Commission on Cancer®-accredited facilities.