Vulvar Cancer in China: Epidemiological Features and Risk Analysis

Abstract

Objective: Describe for the first time the clinical, epidemiological features of vulvar cancer in southwest China. Identify risk factors and provide reference for the prevention of vulvar cancer. Method: We retrospectively analyzed 885 patients admitted to the West China Second University Hospital for vulvar diseases between 2006 and 2016. Vulvar cancer patients with previously diagnosed vulvar nonneoplastic epithelial disorders (n=132) were analyzed and compared to those without prior history of vulvar nonneoplastic epithelial disorders (n=219). Comparisons were also made among cancer patients and non-cancer patients with vulvar nonneoplastic epithelial disorders (n=288) and vulvar squamous intraepithelial lesions (n=246). The risk factors leading to vulvar cancer for the patients with vulvar nonneoplastic epithelial disorder were analyzed by univariate analysis. Furthermore, differences of the epidemiological features of vulvar nonneoplastic epithelial disorders, vulvar squamous intraepithelial lesion and vulvar cancer were identified. Results: According to the univariate analysis, age, first coital age, educational level, smoking, history of vaginal atrophy, HPV infection, lesion sites of the upper vulva and histo-pathological changes are strongly positively correlated with vulvar cancer. By comparing the features of vulvar cancer with those of the vulvar nonneoplastic epithelial disorder and vulvar squamous intraepithelial lesion, we found that on average patients with vulvar cancer had the highest age (ranged from 50 to 59), the lowest first coital age and the highest number of pregnancies and births. The incidences of vulvar nonneoplastic epithelial disorder and vulvar cancer were 1/1000 and 2.5/100,000 respectively with an increasing trend during last 10 years. Conclusion: Age, first coital age, educational level, smoking, atrophic vagina history, HPV infection, lesion sites of the upper vulva and histo-pathological changes are the risk factors that lead to vulvar cancer. Vulvar nonneoplastic epithelial disorder, vulvar squamous intraepithelial lesion and vulvar cancer each has distinct epidemiological features. Prompt surgical intervention and subsequent treatments are the key to a better outcome of vulvar cancer.

High-risk human papillomavirus-associated vulvar neoplasia among women living with human immunodeficiency virus in Zambia

“…Although they have been identified as risk factors of vulvar cancer, the smoking of cigarettes, alcohol use, use of oral contraceptives, and early sexual debut were not associated with VSCC or uVIN in our cohort of participants. 31 , 32 Also, the finding that 90% of patients with VSCC had been on ART for over a year supports previous reports that ART does not affect the regression of low- or high-grade lesions and has no effect on the prevention or elimination of HPV infection. 33 , 34 , 35 , 36 …”

Cancer of the vulva

“…Reinforcing this epidemiological change, differences in terms of current incidence or age at presentation can be found between countries and regions; some may be explained by a different local HPV prevalence or other risk factors (e.g. ethnic distribution, smoking, atrophy or inflammation, HIV) …”

Differences in site‐specific incidence and relative survival of cutaneous and mucocutaneous genital squamous cell carcinoma in Germany, 2007‐2015

“…After age stratification (<60 and ≥60 years), there was an increase for women <60 years and a practically constant value for women ≥60 years 39 . Risk factors for female mucocutaneous genital SCC include advanced age, young age at first coitus, multiple gestations, history of genital HPV‐infection, vulvar dystrophy, smoking and compromised immunity 8,40 . Estimated 5‐year relative survival of vulvar cancers in Europe varies between 58% (Austria) and 73% (Netherlands) 41 .…”

“…Notably, SCC account for more than 90% of malignant tumors of the vulva 7 . One type of vulvar SCC occurs especially in the elderly and develops from lichen sclerosus, a precursor lesion of mucocutaneous genital SCC; the other type occurs more frequently among younger women and develops from vulvar intraepithelial neoplasia (VIN) caused by HPV infection 8‐10 . The most common (about 95%) penile malignancy is also SCC 11 that can be etiologically categorized into two groups: one type develops mainly in the presence of phimosis or chronic inflammation (balanitis) often related to a lack of circumcision and poor hygiene; the second type develops from HPV infection, especially serotypes 6, 11, 16 and 18 12 .…”