# The impact of absent vulvar cancer screening guidelines on outcomes of vulvar squamous cell carcinoma: a national cancer database study

## TL;DR

This study finds that older patients with vulvar cancer have worse outcomes, suggesting a need for better screening guidelines for vulvar squamous cell carcinoma.

## Contribution

The study identifies a significant survival disparity in older VSCC patients and highlights the lack of screening guidelines for this population.

## Key findings

- Patients aged ≥75 had a 330% higher risk of mortality compared to the 50–64 age group.
- Older patients (≥65) were more likely to have advanced-stage vulvar squamous cell carcinoma.
- Survival outcomes worsened with increasing age, with the oldest cohort having the lowest mean survival.

## Abstract

To analyze current vulvar squamous cell carcinoma (VSCC) data with respect to age groups and determine if gynecologic cancer screening guidelines address the burden of VSCC on the ≥ 65 cohort.

Patient data from 2004 to 2021 was identified from the National Cancer Database using ICD-10 codes specific for the vulva, and ICD-O-3 histology codes for squamous cell carcinoma or premalignant vulvar intraepithelial neoplasia Grade III. GraphPad Prism and IBM SPSS were used to analyze variable frequency with cross analysis. Chi-squared tests, Kaplan–Meier survival curves with log-rank comparison, and Cox proportional hazard regression models were utilized for statistical analysis. For regression models of hazard ratios (HRs) and odds ratios (ORs), the 50–64-year-old cohort was used as a reference variable.

The patient population was 68,153. Mean overall survival decreased as age increased (≤ 49 years old was 184.9 months, 50–64 years old was 152.1 months, 65–74 years old was 107.3 months, and ≥ 75 years old was 57.7 months). The ≥ 75-year-old cohort had a 330% higher risk of mortality when compared to the reference variable (HR 4.3, p < 0.001), followed by the 65–74-year-old cohort (HR 1.96, p < 0.001). The ≥ 75 years old and 65–74-year-old cohorts had the highest likelihood of advanced VSCC (OR 1.91, p < 0.001 and OR 1.37, p < 0.001, respectively).

Patients ≥ 65 years old are significantly more likely to experience worse survival outcomes and higher stage diseases, indicating that a lack of screening protocols may influence VSCC outcomes.