The prognostic value of surgery in patients with locally advanced vulvar cancer: results from the SEER database and a Chinese multicenter registry

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OBJECTIVE: The therapeutic role of surgery in locally advanced vulvar cancer (LAVC) remains controversial based on current National Comprehensive Cancer Network and International Federation of Gynecology and Obstetrics (FIGO) guidelines. This multicenter study aimed to investigate the prognostic value of surgery in LAVC patients. METHODS: LAVC patients (T2 stage with tumor >4 cm; and T3 stage) were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database and the Chinese multicenter registry. The primary outcome was cancer-specific survival (CSS). The difference in CSS between the surgery group and non-surgery group was evaluated through Cox regression analyses and Kaplan-Meier analyses. To enhance the robustness of our findings, propensity score matching (PSM) and sensitivity analyses were also applied. RESULTS: A total of 936 LAVC patients were included in the final analysis. Multivariable Cox regression analyses showed that surgery was associated with better CSS in LAVC patients, both in the SEER cohort (hazard ratio [HR]=0.55; 95% confidence interval [CI]=0.41-0.73; p<0.001) and the Chinese cohort (HR=0.31; 95% CI=0.14-0.71; p=0.006). Meanwhile, in the SEER cohort, the Kaplan-Meier analyses showed that the surgery group had better CSS than the non-surgery group both before (p<0.001) and after PSM cohorts (p=0.003). The Chinese cohort also demonstrated significantly improved CSS in the surgical group than the non-surgical group (p<0.001). CONCLUSION: Surgery was associated with better survival in patients with LAVC. Further prospective studies are warranted.

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