The influence of age on treatment and prognosis of patients with squamous cell vulvar cancer (VSCC)- a subset analysis of the AGO-CaRE-1 study

Background Despite an increasing incidence with decreasing age of onset, the impact of age on prognosis and treatment patterns in VSCC has not been studied yet.

Methods This is a subgroup analysis of the AGO-CaRE-1 study. Patients with primary VSCC (FIGO: ≥1B), treated at 29 cancer centers in Germany (1998 -2008), were included in a centralized database (n=1618). In this subgroup analysis patients were analyzed according to age (< 50yrs (n=220), 50-69yrs (n=506), ≥70yrs (n=521)) with regard to treatment patterns and prognosis. Only patients with documented age, surgical groin staging and known nodal status were included (n=1247). Median follow-up was 27.5 months.

Results At first diagnosis, women >70yrs presented with more advanced tumor stages (< 0.001), larger tumor diameter (< 0.001), poorer ECOG status (< 0.001), higher tumor grading (0.048), a higher rate of nodal involvement (< 0.001) and HPV negativity (0.03) compared to the other age groups. 2- year DFS was 81.1 % (< 50yrs), 65.8 % (50-69yrs), and 59.3 % (≥70yrs), respectively. In a multivariate analysis age, ECOG, tumor stage, grading and receipt of (chemo)radiation were independent predictive factors for death or recurrence. Elderly had a higher risk for death or recurrence, compared to the youngest group (HR:3.21, p< 0.001). In case of recurrence, elderly showed more isolated vulvar recurrences (18.2 % vs. 15.2 % in 50-69yrs vs. 12.7 % in < 50yrs, p=0.001).

Conclusions Older women present with advanced disease at first diagnosis in comparison to younger patients. Potential reasons could be self-awareness and/or more aggressive tumor biology due to HPV negative disease.

Publication History

Article published online:
07 October 2020