Survival disparities in vulvar cancer patients in Commission on Cancer®-accredited facilities.

Objectives: To investigate survival disparities and prognostic factors in vulvar cancer by age at diagnosis.
Methods: Women who underwent surgery and were diagnosed with stage I-IV vulvar cancer from 2004 to 2014 in the National Cancer Database were eligible. Proportions were compared using Chi-Square test. Survival was evaluated using Cox analysis.
Results: There were 18,207 eligible women. Median age at diagnosis was 64 years, and 31% diagnosed ≥75 years old were categorized as elderly. Most vulvar cancers were diagnosed at stage I and with squamous histology. Diagnosis with higher stage or non-squamous histology was more common in elderly vs. non-elderly patients (P < 0.001). Survival was 3.5 times worse in the elderly than the non-elderly (P < 0.0001). Risk of death for each 5-year increment in age increased by 22% for non-elderly and 43% for elderly patients (P < 0.0001). The prognostic value of comorbidity score, stage, regional node assessment and histology was smaller in elderly vs. non-elderly women (each P < 0.05). Adjuvant chemoradiotherapy (CTRT) use in the elderly vs. non-elderly was rare for stage I-II disease (3% vs. 2%) and more common for stage III-IV disease (6% vs. 43%), respectively (P < 0.0001). The survival disadvantage for elderly patients persisted following no adjuvant therapy, radiotherapy or chemotherapy alone, or CTRT (P < 0.0001). In stage III-IV disease, survival was superior following CTRT vs. radiotherapy when diagnosed <75 years (HR = 0.80, 95% CI = 0.69-0.93) but not in the elderly (HR = 0.99, P > 0.05).
Conclusions: Age-associated risk of death increased at different rates in vulvar cancer and was larger in elderly vs. non-elderly patients. The impact of other prognostic factors was smaller in elderly vs. non-elderly women. The survival benefit of CTRT over radiotherapy in stage III-IV did not extend to the elderly.
Competing Interests: Declaration of competing interest NBG, JLL, CT, AJ, SDR, CDS, GLM and KMD have no conflicts of interest to disclose. KO-B's spouse works for Pharmacyclics and owns AbbVie restricted stock in the amount of approximately $50,000 that vests over 3 years. TCK is a consultant, received honoraria and reimbursement, and is on the Speakers' Bureau for Tasaro, Astra Zeneca, Caris Life Sciences, Clovis and Genetech. YC's spouse owns <5k stock interest in Celsion. YC's spouse owns <5k stock interest in Celsion.
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