Prognostic indicators and survival rates in vulvar cancer: insights from a retrospective study

Abstract

Background: This study aimed to ascertain prognostic indicators impacting progression-free survival (PFS) and overall survival (OS) in patients diagnosed with vulvar cancer. The secondary aim was to determine a quantifiable measure of PFS and OS for these patients. Methods: A comprehensive retrospective review was conducted of the medical records of vulvar cancer patients treated at Siriraj Hospital from 2006 to 2020. Patient characteristics, surgical outcomes, pathological features and immunohistochemical results for p16, p53 and PD-L1 were analysed for their potential as prognostic indicators for survival outcomes. Results: In the sample of 104 vulvar cancer patients, four factors were significantly associated with a worsening PFS. They were coexisting vulvar lesions such as lichen sclerosus and extramammary Paget’s disease (p = .008); lymphovascular space invasion (LVSI; p = .011); pelvic or paraaortic lymph node metastases (p = .042); and positive p53 status (p = .046). Additionally, a tumour size exceeding 4 cm in diameter was significantly linked with decreased OS (p = .001). The median PFS and OS were calculated as 26.3 and 44.7 months, respectively. Significantly improved PFS and OS were noted in patients with a positive p16 or a negative p53 immunohistochemical profile. The calculated hazard ratios for these two subsets were 3.032 (95% CI = 1.419–6.480; p = .004) and 2.421 (95% CI = 1.120–5.232; p = .025), respectively. Conclusions: Factors leading to unfavourable PFS are coexisting vulvar lesions, positive LVSI status, pelvic or paraaortic lymph node metastases, and positive p53 status. Regarding OS, a tumour diameter exceeding 4 cm significantly correlates with poorer outcomes.