Management and outcomes for elderly women with vulvar cancer over time

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 121; no. 6; pp. 719 - 727
• Main Authors: Rauh‐Hain, JA, Clemmer, J, Clark, RM, Bradford, LS, Growdon, WB, Goodman, A, Boruta, DM, Dizon, DS, Schorge, JO, Carmen, MG
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-05-2014
• Subjects: Age Distribution; Age Factors; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - prevention & control; Carcinoma, Squamous Cell - therapy; Elderly; Female; Genital cancers; Gynecologic Surgical Procedures - statistics & numerical data; Gynecology; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Neoplasm Staging; Older people; Proportional Hazards Models; Radiotherapy - statistics & numerical data; Retrospective Studies; Risk Factors; SEER Program; Sentinel Surveillance; Time Factors; United States - epidemiology; vulvar cancer; Vulvar Neoplasms - mortality; Vulvar Neoplasms - pathology; Vulvar Neoplasms - prevention & control; Vulvar Neoplasms - therapy; United States; Elderly; vulvar cancer
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.12580

Objective
To examine changes over time in survival and treatment for women diagnosed with vulvar squamous cell carcinoma included in the Surveillance, Epidemiology, and End Results (SEER) Program.
Design
Retrospective analysis.
Setting
USA, data obtained from the SEER Program for 1988–2009.
Population
Women with vulvar squamous cell carcinoma.
Methods
Women were stratified by age: <50, 50–64, 65–79, and ≥80 years. Differences in survival and treatment patterns were analysed between age groups. Multivariate logistic regression models were constructed to examine treatment patterns. Kaplan–Meier and Cox proportional hazards survival methods were used to assess survival.
Main outcome measures
Vital status from the date of diagnosis until death, censoring or last follow‐up.
Results
The final study group consisted of 8553 women, 1806 (21.12%) <50 years, 2141 (25.03%) 50–64 years, 2585 (30.22%) 65–79 years, and 2021 (23.63%) >80 years old. After adjusting for patient and tumour characteristics, older women were less likely to have surgery and more likely to receive radiotherapy. Compared with women under 50 years, women 50–64 had a two‐fold higher risk of death (HR 1.91, 95% CI 1.55–2.34); those 65–79 years had a four‐fold higher risk of death (HR 4.01, 95% CI 3.32–4.82), and those ≥80 years had a seven‐fold higher risk of death (HR 6.98, 95% CI 5.77–8.46). These trends stayed relatively constant over the time periods studied.
Conclusions
Women over 50 years are at a higher risk of vulvar cancer‐specific mortality, which increases with age. These trends stayed relatively constant over the time periods studied.