# Prognostic factors for lymph node infestation, long-term survival and recurrence rates in patients with vaginal cancer: a population-based study in Germany

## TL;DR

This study identifies factors affecting survival and recurrence in vaginal cancer patients using data from Germany, highlighting treatment and risk factors.

## Contribution

The study provides population-based insights into prognostic factors and treatment outcomes for vaginal cancer, a rare malignancy.

## Key findings

- Younger age, larger tumor size, and lymphatic invasion are significant risk factors for lymph node involvement.
- Surgery plus radiochemotherapy showed the best survival outcomes compared to other treatments.
- Cumulative recurrence rates increased over time, reaching 24.3% for locoregional and 16.5% for distant metastases after 10 years.

## Abstract

Vaginal cancer (ICD-10: C52) is one of the rarest gynecological malignancies, with limited research on its frequency, long-term survival, therapy-dependent survival, and follow-up of recurrences. This knowledge deficit may lead to potential consequences such as medical over-, under- or wrong therapy.

This nationwide retrospective population-based registry study analyzed patients with vaginal cancer diagnosed between 2000 and 2022 in Germany. A total cohort of 1325 patients was included. To assess prognostic factors related to lymph node involvement, overall survival, recurrence rates, and therapy-dependent survival were analyzed using binary logistic regression, the Kaplan-Meier method, and univariable and multivariable Cox regression.

Mean age at diagnosis was 68.5 years and median age was 70.4 years. 30.0% (n = 398) of patients showed lymph node involvement. Younger age at diagnosis (< 60 years), larger tumor size, and lymphatic invasion were noted as significant risk factors for lymph node involvement in multivariable analysis. The 5-year overall survival rate was 53.8% (95%-CI 50.9–56.7), significantly influenced by age at diagnosis, nodal status, and tumor size in multivariable analysis. Cumulative recurrence rates for locoregional and distant metastases were 20.4% and 14.3% after 5 years, increasing to 24.3% and 16.5% after 10 years. The most common primary treatment was surgery (39.2%, n = 454). Surgery plus radiochemotherapy (OP + RCT) provided the most favorable outcome as a primary treatment, whereas radiotherapy alone showed the least benefit of all treatment options.

Our study identifies important prognostic factors influencing vaginal cancer survival and offers information on treatment optimization.

The online version contains supplementary material available at 10.1007/s00432-026-06436-6.