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Open AccessArticle

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

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Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, USA
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Department of Health Management, Tokai University, Hiratsuka, Kanagawa 259-1292, Japan
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Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo 673-0021, Japan
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Department of Gynecologic Oncology, Cancer Institute Hospital of JFCR, Tokyo 135-0063, Japan
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Department of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0245, Japan
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Department of Gynecologic Oncology, Shizuoka Cancer Center, Shizuoka 411-0934, Japan
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Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa 216-8511, Japan
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Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi 980-8574, Japan
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Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan
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Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
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Department of Gynecology, Saitama Cancer Center, Saitama 362-0806, Japan
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Department of Gynecology, Niigata Cancer Center Hospital, Niigata 951-8133, Japan
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Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata 951-8510, Japan
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Department of Obstetrics and Gynecology, Tokai University Hospital, Isehara, Kanagawa 259-1193, Japan
*
Authors to whom correspondence should be addressed.
Abstract of the study was presented at the 2019 Congress Meeting for European Society for Medical Oncology, Barcelona, Spain, 27 September–1 October 2019.
Authors contributed equally to the work.
J. Clin. Med. 2019, 8(12), 2081; https://doi.org/10.3390/jcm8122081
Received: 30 October 2019 / Revised: 18 November 2019 / Accepted: 23 November 2019 / Published: 29 November 2019
(This article belongs to the Section Obstetrics & Gynecology)
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. View Full-Text
Keywords: vulvar cancer; trends; demographics; elderly; survival; Japan vulvar cancer; trends; demographics; elderly; survival; Japan
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Nishio, S.; Matsuo, K.; Shibata, T.; Yamaguchi, S.; Kanao, H.; Takehara, K.; Kado, N.; Tozawa, A.; Tokunaga, H.; Matsunaga, T.; Kato, H.; Horie, K.; Kikuchi, A.; Enomoto, T.; Mikami, M. Changes in the Clinicopathological Demographics of Vulvar Cancer in Japan: Increasing Oldest-Old, Stage Shifting, and Decreasing Cohort-Level Survival . J. Clin. Med. 2019, 8, 2081.

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