Abstract | BACKGROUND: METHODS: The NCDB was queried for vulvar cancer patients diagnosed from 1998-2011 who underwent extirpative surgery with confirmed inguinal nodal involvement treated with adjuvant radiotherapy. Patients with inadequate follow-up or non-squamous histologies were excluded. Chi-square test, logistic regression analysis, log-rank test and multivariable Cox proportional regression modeling with adjustment using propensity score with inverse probability of treatment weights (IPTW) were conducted to establish factors associated with utilization and survival. RESULTS: A total of 1797 patients were identified: 26.3% received adjuvant chemotherapy and 76.6% had 1-3 involved lymph nodes. Adoption of adjuvant chemotherapy significantly increased over time, from 10.8% in 1998 to 41.0% in 2006 (p<0.001). Lower utilization was seen in older patients, Northeast or Southern facilities, and patients with more extensive nodal dissection, whereas greater number of involved nodes, stage IVA disease and positive surgical margins led to a higher probability of receiving chemotherapy. Unadjusted median survival without and with adjuvant chemotherapy was 29.7months and 44.0months (p=0.001). On IPTW-adjusted Cox proportional regression modeling, delivery of adjuvant chemotherapy resulted in a 38% reduction in the risk of death (HR 0.62, 95% CI 0.48-0.79, p<0.001). CONCLUSION:
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Authors | Beant S Gill, Mark E Bernard, Jeff F Lin, Goundappa K Balasubramani, Malolan S Rajagopalan, Paniti Sukumvanich, Thomas C Krivak, Alexander B Olawaiye, Joseph L Kelley, Sushil Beriwal |
Journal | Gynecologic oncology
(Gynecol Oncol)
Vol. 137
Issue 3
Pg. 365-72
(Jun 2015)
ISSN: 1095-6859 [Electronic] United States |
PMID | 25868965
(Publication Type: Journal Article)
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Copyright | Copyright © 2015 Elsevier Inc. All rights reserved. |
Topics |
- Adult
- Aged
- Aged, 80 and over
- Chemoradiotherapy, Adjuvant
- Chemotherapy, Adjuvant
- Cohort Studies
- Female
- Humans
- Lymphatic Metastasis
- Middle Aged
- Practice Guidelines as Topic
- Radiotherapy, Adjuvant
- Retrospective Studies
- United States
- Vulvar Neoplasms
(drug therapy, pathology, radiotherapy, surgery)
- Young Adult
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