Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Gynecol Oncol. 2021 May;161(2):442-448. doi: 10.1016/j.ygyno.2021.02.025. Epub 2021 Feb 26.
Despite an increasing incidence with simultaneous decreasing age of onset, vulvar squamous cell carcinoma (VSCC) is still a disease that mainly effects the elderly population. Data on the association of age with prognosis and treatment patterns in VSCC are sparse.
This is an analysis of the AGO-CaRE-1 cohort. Patients with VSCC (FIGO stage ≥1B), treated at 29 cancer centers in Germany from 1998 to 2008, were included in a centralized database (n = 1618). In this subgroup analysis patients were analyzed according to age [<50 yrs. (n = 220), 50-69 yrs. (n = 506), ≥70 yrs. (n = 521)] with regard to treatment patterns and prognosis. Only patients with documented age, surgical groin staging and known nodal status were included (n = 1247). Median follow-up was 27.5 months.
At first diagnosis, women ≥70 yrs. presented with more advanced tumor stages (<0.001), larger tumor diameter (<0.001), poorer ECOG status (<0.001), more frequent HPV negative tumors (p = 0.03) as well as a higher rate of nodal involvement (<0.001). Disease recurrence occurred significantly more often in elderly patients (p = 0.001) and age as well as ECOG status, microscopic residual resection, tumor stage, grading, and (chemo)radiation were independent prognostic factors for death or recurrence in multivariate analysis. 2-year disease-free survival rates were 59.3% (≥70 yrs), 65.8% (50-69 yrs) and 81.1% (<50 yrs), respectively (p < 0.001).
Older women with VSCC present with advanced tumor stages at first diagnosis and have an increased risk of recurrence as well as a decreased 2-year DFS in comparison to younger patients. Potential reasons could be self-awareness and/or more aggressive tumor biology due to HPV independent disease.
尽管外阴鳞状细胞癌（VSCC）的发病率不断上升，同时发病年龄也在逐渐下降，但它仍然是一种主要影响老年人群的疾病。关于年龄与 VSCC 预后和治疗模式之间的关系的数据很少。
这是一项对 AGO-CaRE-1 队列的分析。纳入了 1998 年至 2008 年期间在德国 29 家癌症中心接受治疗的 FIGO 分期≥1B 的 VSCC 患者（n=1618），并将其纳入集中数据库。在此亚组分析中，根据年龄[<50 岁（n=220）、50-69 岁（n=506）、≥70 岁（n=521）]分析患者的治疗模式和预后。仅纳入有记录年龄、外科腹股沟分期和已知淋巴结状态的患者（n=1247）。中位随访时间为 27.5 个月。
初次诊断时，≥70 岁的女性患者肿瘤分期更晚（<0.001）、肿瘤直径更大（<0.001）、ECOG 状态更差（<0.001）、HPV 阴性肿瘤比例更高（p=0.03），淋巴结受累率也更高（<0.001）。老年患者疾病复发的发生率明显更高（p=0.001），年龄、ECOG 状态、显微镜下残留肿瘤、肿瘤分期、分级和（放）化疗是多因素分析中死亡或复发的独立预后因素。2 年无病生存率分别为 59.3%（≥70 岁）、65.8%（50-69 岁）和 81.1%（<50 岁）（p<0.001）。
与年轻患者相比，初次诊断时患有 VSCC 的老年女性患者肿瘤分期更晚，复发风险更高，2 年无病生存率降低。可能的原因是由于 HPV 不相关的疾病，导致自我意识和/或更具侵袭性的肿瘤生物学。
