Invasive cancer of the vulva

This study comprised 328 patients with histologically confirmed primary invasive vulvar cancer, treated between 1948 and 1994. It retrospectively analyzes survival rates in relation to various prognostic factors. Mean and median age at diagnosis was 69 years (n = 328). The patients had experienced various symptoms on an average of 16.3 months prior to diagnosis (median, 6 months). Common presenting symptoms were pruritus, smarting pain, and vulvar tumor. Three hundred patients (91.5%) had squamous cell carcinomas and they were classified according to stage and tumor differentiation as follows: Stage I, 106 (35%); Stage II, 111 (37%); Stage III, 44 (15%); and Stage IV, 39 (13%); well differentiated, 107 (36%); moderately differentiated, 129 (43%); poorly or undifferentiated, 45 (15%); and in 19 cases (6%), tumor differentiation was not available. In 277 (92%) patients the primary treatment was surgical; 189 (63%) patients additionally received radiotherapy and 13 (4%) patients were also given chemotherapy. In 18 patients (6%), the primary treatment was radiotherapy and 5 of these also received chemotherapy. Two patients were given primary chemotherapy and three patients received no treatment. Median survival rate was not reached during the observation time for Stage I. At 10 years observation time survival rate was 85% in this stage. Median survival times for Stages II, III, and IV were reached at 128, 20, and 8 months observation time, respectively. The median survival time in patients with well-differentiated tumors was 152 months; corresponding figures for moderately differentiated and poorly differentiated tumors were 114 and 74 months, respectively. The most important prognostic factors in this study were tumor stage (P < 0.00001), patient age (P < 0.01), and tumor differentiation (P = 0.02).