# Impact of the COVID-19 Pandemic on Tumor Stage and Pathohistological Parameters of Vulvar Cancer

## TL;DR

This study examines how the COVID-19 pandemic affected the staging and characteristics of vulvar cancer in a high-incidence region in Germany.

## Contribution

The study provides new insights into the impact of the pandemic on vulvar cancer staging and tumor characteristics in a specific region.

## Key findings

- No significant differences in age, T-stage, or resection status were found between pre-, during, and post-COVID cohorts.
- Lymphovascular infiltration and tumor depth were greater before the pandemic.
- Patient care quality remained consistent during the pandemic based on resection margin status.

## Abstract

Background/Objectives: Vulvar cancer (VC) comprises a small fraction of female neoplasms with notable high-incidence clusters among German regions. Despite a proposed impact of nationwide lockdowns in response to the COVID-19 pandemic on oncological diseases, the effect on VC staging and tumor characteristics remains yet to be resolved; therefore, analyzing pathological data from patients with squamous cell VC pre-, during, and post-COVID in a high-incidence region may offer insights into potential epidemiological and clinical trends. Methods: We identified a total of 90 patients who were diagnosed at the Institute of Pathology, University Hospital Saarland, between 2018 and 2023, and defined three distinct cohorts: a pre-COVID cohort (2018–2019), a COVID cohort (2020–2021), and a post-COVID cohort (2022–2023). Histomorphological data were collected from the individual patient reports and statistically analyzed using Fisher’s exact test or the Kruskal–Wallis test. Results: Although we found no statistically significant differences in age, T-stage, perineural infiltration, blood vessel infiltration, resection status, grading, or resection margin between our three cohorts, surprisingly, we determined a greater extent of lymphovascular infiltration (Fisher’s exact test; p = 0.041), as well as deeper tumor infiltration depth (Kruskal–Wallis test; p < 0.001) before the COVID-19 pandemic. Furthermore, we did not identify any soft indications of abnormalities in patient care within our center (unchanged status of the resection margins across all three cohorts). Conclusions: Our results clearly do not support a negative affection of clinical or pathobiological characteristics of VC during or after the pandemic. However, final assessments regarding the pandemic’s effect on VC require additional study approaches in various regions, preferably with future extended timeframes of a longer follow-up.