DOI: 10.6084/m9.figshare.28751783.v1
title: Prognostic indicators and survival rates in vulvar cancer: insights from a retrospective study

description: This study aimed to ascertain prognostic indicators impacting progression-free survival (PFS) and overall survival (OS) in patients diagnosed with vulvar cancer. The secondary aim was to determine a quantifiable measure of PFS and OS for these patients. A comprehensive retrospective review was conducted of the medical records of vulvar cancer patients treated at Siriraj Hospital from 2006 to 2020. Patient characteristics, surgical outcomes, pathological features and immunohistochemical results for p16, p53 and PD-L1 were analysed for their potential as prognostic indicators for survival outcomes. In the sample of 104 vulvar cancer patients, four factors were significantly associated with a worsening PFS. They were coexisting vulvar lesions such as lichen sclerosus and extramammary Paget’s disease (<i>p</i> = .008); lymphovascular space invasion (LVSI; <i>p</i> = .011); pelvic or paraaortic lymph node metastases (<i>p</i> = .042); and positive p53 status (<i>p</i> = .046). Additionally, a tumour size exceeding 4 cm in diameter was significantly linked with decreased OS (<i>p</i> = .001). The median PFS and OS were calculated as 26.3 and 44.7 months, respectively. Significantly improved PFS and OS were noted in patients with a positive p16 or a negative p53 immunohistochemical profile. The calculated hazard ratios for these two subsets were 3.032 (95% CI = 1.419–6.480; <i>p</i> = .004) and 2.421 (95% CI = 1.120–5.232; <i>p</i> = .025), respectively. Factors leading to unfavourable PFS are coexisting vulvar lesions, positive LVSI status, pelvic or paraaortic lymph node metastases, and positive p53 status. Regarding OS, a tumour diameter exceeding 4 cm significantly correlates with poorer outcomes. A retrospective study conducted at Siriraj Hospital in Thailand analysed 104 vulvar cancer patients treated between 2006 and 2020. The mean patient age was 63 years, with 72.1% being postmenopause. Squamous cell carcinoma (SCC) was the predominant histological type, observed in 78.9% of cases. Immunohistochemical analysis revealed positive expression of p16 and p53 in 33.7% of tumours each, while PD-L1 positivity was found in 19.8% of cases. The study identified several factors associated with poorer progression-free survival (PFS) and overall survival (OS). Multivariate analysis indicated that coexisting lesions such as Paget’s disease and lichen sclerosus, positive lymphovascular space invasion (LVSI), pelvic or para-aortic lymph node involvement, and positive p53 expression were significantly linked to reduced PFS. Additionally, a tumour size greater than 4 cm was associated with decreased OS. These findings align with previous research highlighting the prognostic significance of p16 and p53 expression in vulvar cancer. The role of PD-L1 expression in vulvar cancer prognosis remains inconclusive, with some studies suggesting a potential association with survival outcomes, while others do not. Strengths of this study include its comprehensive analysis of clinical, pathological and immunohistochemical factors within a single cohort. However, limitations such as its retrospective design, relatively small sample size and potential selection bias may affect the generalisability of the results.