Gynaecology, Gynaecologic Oncology and Obstetrics, Evangelisches Krankenhaus Kalk, Koln, Germany.
Institute of Medical Statistics and Computational Biology, Medical Faculty of the University of Cologne, Koln, Germany.
BMJ Open. 2024 Aug 28;14(8):e077960. doi: 10.1136/bmjopen-2023-077960.
To evaluate the 5-year survival rate of patients with vulvar cancer, taking into account prognostic factors (International Federation of Gynecology and Obstetrics (FIGO) stage and age) and the influence of lymph node involvement and tumour size as well as the correlation between FIGO stage and age at onset.
Retrospective cohort study.
German cancer registries.
The study included 17 017 patients diagnosed with vulvar cancer between 2004 and 2014 with follow-up until 2017. Exclusion criteria were incomplete documentation, age<18 years and death certificate only.
The primary outcome was overall and relative survival according to FIGO stage and age and the distribution of FIGO stages by age group. Secondary outcomes analysed were tumour size and lymph node status as risk factors for mortality.
The median age at diagnosis was 70 years. The overall 5-year survival rate was 69.5% (95% CI: 68.7% to 70.3%). The 5-year relative survival rates ranged from 91.9% (95% CI: 90.5% to 93.3%) to 21.3% (95% CI: 15.6% to 27.0%) for FIGO I to FIGO IVB and from 89.2% (95% CI: 87.6% to 90.8%) to 68.0% (95% CI: 65.3% to 70.7%) for age groups <55 to >75 years. Younger patients were significantly more often diagnosed with a low FIGO stage (p<0.001). Lymph node status and tumour size were independent factors influencing survival (HR: 1.79 (95% CI: 1.73 to 1.84; p<0.001) and 1.88 (95% CI: 1.80 to 1.96); p<0.001, respectively). The median follow-up time was 57 months.
Notably, the steepest decline in survival occurred within the first 3 years after diagnosis. Patients with the highest FIGO stages and those in the oldest age group had the worst survival rates. Furthermore, patients in the oldest age group were more likely to be diagnosed at higher stages. Lymph node status and tumour size were additional independent prognostic factors for mortality.
评估外阴癌患者的 5 年生存率，考虑到预后因素（国际妇产科联合会（FIGO）分期和年龄）以及淋巴结受累和肿瘤大小的影响，以及 FIGO 分期与发病年龄的相关性。
回顾性队列研究。
德国癌症登记处。
该研究纳入了 2004 年至 2014 年间诊断为外阴癌的 17017 例患者，随访至 2017 年。排除标准为资料不完整、年龄<18 岁和仅死亡证明。
主要结局是根据 FIGO 分期和年龄以及按年龄组分布的 FIGO 分期评估的总生存率和相对生存率。分析的次要结局是肿瘤大小和淋巴结状态作为死亡率的危险因素。
中位诊断年龄为 70 岁。总体 5 年生存率为 69.5%（95%CI：68.7%至 70.3%）。FIGO I 至 FIGO IVB 的 5 年相对生存率范围为 91.9%（95%CI：90.5%至 93.3%）至 21.3%（95%CI：15.6%至 27.0%），年龄组<55 岁至>75 岁的生存率范围为 89.2%（95%CI：87.6%至 90.8%）至 68.0%（95%CI：65.3%至 70.7%）。年轻患者更常被诊断为低 FIGO 分期（p<0.001）。淋巴结状态和肿瘤大小是影响生存的独立因素（HR：1.79（95%CI：1.73 至 1.84；p<0.001）和 1.88（95%CI：1.80 至 1.96）；p<0.001）。中位随访时间为 57 个月。
值得注意的是，诊断后前 3 年内生存率下降最为陡峭。FIGO 分期最高和年龄最大组的患者生存率最差。此外，年龄最大组的患者更有可能被诊断为较高的分期。淋巴结状态和肿瘤大小是死亡的额外独立预后因素。
