Abstract
Vulvar Squamous Cell Carcinoma (VSCC) incidence rates and clinical outcomes are correlated with demographic factors, but no study expansively investigates demographic and prognostic factors of VSCC in relation to survival in the post-Gardasil era. This study aims to investigate underlying disparities in VSCC and correlate these factors with survival.
Patients were identified from the National Cancer Database using ICD-10 codes specific for vulvar structures, ICD-O-3 histology codes for squamous cell carcinoma and pre-malignant vulvar intraepithelial neoplasia Grade III (VIN3), and patient data from 2007 to 2021. Statistical analyses utilized IBM SPSS and GraphPad Prism to determine variable frequency with cross analysis and Chi-Squared tests, Kaplan Meier Survival Curves with Log-Rank Pairwise Comparison, and Cox Proportional Hazards Regression Models.
The total patient population was 58,732 patients after inclusion criteria. The median age of diagnosis was 64.0 years old. Significant prognostic factors resulting in better survival included VIN3 histology, lower Charlson-Deyo Score, Black race, receiving care from Academic/Research Programs, private insurance, and median income greater than $63,000. Surgical procedures were significant in improving survival. Black patients are diagnosed younger than White and Other races. A histology type of VIN3 was associated with increased survival time, indicating early identification and treatment for better outcomes.
Key demographic and prognostic factors that influence survival were identified across the VSCC population. This study may serve as a tool in reevaluation of current gynecological screening protocols to promote early diagnosis and management for the entire VSCC patient population.
•Black patients frequently did not have lymph nodes examined.•Lack of gynecologic oncology care in rural areas worsens prognosis.•Public insurance had worse survival, revealing gaps in coverage in gynecologic care.