Changes in the Clinicopathological Demographics of Vulvar Cancer in Japan: Increasing Oldest-Old, Stage Shifting, and Decreasing Cohort-Level Survival †

Abstract

Background: To examine trends in the clinicopathological characteristics of vulvar cancer in Japan. Methods: This is a nationwide retrospective study examining consecutive women with vulvar cancer between 2001 and 2010 in Japan (n = 1061). Temporal trends in demographics, tumor characteristics, and survival were assessed by cohort-level analysis. The National Cancer Institute’s Surveillance, Epidemiology, and End Result Program was used for external validation (n = 10,154). Results: The number of oldest-old women aged ≥80 years significantly increased (from 18.0% in 2001 to 30.6% in 2010; 70.5% relative increase) in the study period. A stage shift was observed, with stage I disease decreasing from 43.0% to 34.0% (21.0% relative decrease), and tumors with distant metastases increasing from 23.2% to 35.6% (53.3% relative increase, p < 0.05). The number of women who underwent surgical treatment decreased from 84.0% to 69.7% (17.0% relative decrease), whereas utilization of radiotherapy increased from 34.4% to 43.2% (25.7% relative increase) over time (p < 0.05). In the cohort-level analysis, the five-year survival rates significantly decreased from 2001 to 2010 (p < 0.05), specifically, 66.9% to 51.0% for progression-free survival (23.7% relative decrease), 79.5% to 67.9% for cause-specific survival (14.6% relative decrease), and 74.9% to 62.3% for overall survival (16.9% relative decrease). In the patient-level analysis, oldest-old women were less likely to undergo surgical treatment and were independently associated with decreased survival (p < 0.05). In the US cohort, the number of oldest-old women (25.2% to 27.8%) and the five-year cause-specific survival rate (81.8% to 79.9%) remained unchanged during the study period (p > 0.05). Conclusion: Demographics and outcomes of vulvar cancer in Japan significantly changed during the study period. An increasing oldest-old population and a stage shift to more metastatic disease resulted in a cohort-level decrease in survival rates.

Hospital volume-outcome relationship in vulvar cancer treatment: a Japanese Gynecologic Oncology Group study

“…For instance, vulvar reconstruction per plastic surgeons is associated with adequate surgical margin [ 17 ]. Moreover, in a recent German study where the treatment volume is considerably higher than the current study (average 5–6 cases a year per a center), positive margin rate is significantly low (9.9% vs. 22.4%) [ 15 18 ]. To this end, centralizing care of vulvar cancer to the centers with adequate treatment resource and quality would be ideal to improve outcome.…”

“…This is a secondary exploratory analysis of a previously organized nationwide retrospective observational study by querying the JGOG-1075S database [ 15 ]. The study protocol was approved by the ethics committee of each participating institution (hosting institution, Kurume University; Institutional Review Board registration No.…”

“…UMIN000017080). Details of study outlines and contents were described previously [ 15 ]. Briefly, this nationwide study examined the consecutive 1,061 women with stage I-IV invasive vulvar cancer who received primary treatment care at 109 JGOG-affiliated centers from 2001–2010.…”

“…In our prior analysis of the JGOG-1075S cohort, there was an impression that treatment patterns varied across the centers [ 15 ]. In addition, more than expected number of close and positive surgical margin as well as absence of lymphadenectomy in indicated cases is certainly concerning.…”

<p>Supplement of Lipid Emulsion to Epinephrine Improves Resuscitation Outcomes of Asphyxia-Induced Cardiac Arrest in Aged Rats</p>

“…1 Despite advances in resuscitation therapies and techniques, the survival rate of CA remained unchanged at 8% over the past decades. 2 In addition, neurological disorders, cardiac insufficiency and other organ dysfunction after return of spontaneous circulation (ROSC) are still intractable. 3,4 Several epidemiological studies have revealed that the risk of CA increases with age.…”