Prognostic impact of clinical tumor size on overall survival for subclassifying stages I and II vaginal cancer: A SEER analysis

Staging by imaging in gynecologic cancer and the role of ultrasound: an update of European joint consensus statements

In recent years the role of diagnostic imaging by pelvic ultrasound in the diagnosis and staging of gynecological cancers has been growing exponentially. Evidence from recent prospective multicenter studies has demonstrated high accuracy for pre-operative locoregional ultrasound staging in gynecological cancers. Therefore, in many leading gynecologic oncology units, ultrasound is implemented next to pelvic MRI as the first-line imaging modality for gynecological cancer. The work herein is a consensus statement on the role of pre-operative imaging by ultrasound and other imaging modalities in gynecological cancer, following European Society guidelines.

Prognostic nomogram and treatment efficacy analysis for vaginal cancer: A SEER database and external validation study

OBJECTIVES

To analyze the prognosis and treatment decisions for patients with vaginal cancer through a large retrospective cohort study, in order to assist clinicians to evaluate the condition and choose treatment methods.

METHODS

This was a retrospective study analyzed with Cox regression, nomogram, and external validation. The Kaplan-Meier curve was used for comparative analysis of various treatment modalities.

RESULTS

A total of 6650 cases of vaginal cancer diagnosed between 2000 and 2018 from the Surveillance, Epidemiology, and End Results database and 106 cases diagnosed between 2006 and 2021 from Fujian Cancer Hospital were identified. Young age, early FIGO (the International Federation of Gynecology and Obstetrics) stage, well-differentiated, squamous and adenocarcinoma, first primary malignancy, married, undergoing surgery, and chemoradiotherapy were good independent prognostic factors (P < 0.001). The internal and external validation concordance indices were 0.7102 and 0.7785, respectively. The Kaplan-Meier curves indicated that surgery, radiotherapy, and chemotherapy significantly improved survival in patients with vaginal cancer. Forest plots suggest that radiotherapy combined with surgery was superior to radiotherapy alone (P < 0.001).

CONCLUSION

We established a specific nomogram to predict vaginal cancer prognosis. Surgery combined with external beam radiation plus brachytherapy may be the most recommended treatment option.

Development and validation of models for predicting the overall survival and cancer-specific survival of patients with primary vaginal cancer: A population-based retrospective cohort study

Background

No models have been developed to predict the survival probability for women with primary vaginal cancer (VC) due to VC’s extreme rareness. We aimed to develop and validate models to predict the overall survival (OS) and cancer-specific survival (CSS) of VC patients.

Methods

A population-based multicenter retrospective cohort study was carried out using the 2004–2018 Surveillance, Epidemiology, and End Results Program database in the United States. The final multivariate Cox model was identified using the Brier score and Harrell’s C concordance statistic (C-statistic). The decision curve, calibration plot, and area under the time-dependent receiver operating characteristic curve (AUC) were used to evaluate model prediction performance. Multiple imputation followed by bootstrap was performed. Bootstrap validation covered the entire statistic procedure from model selection to baseline survival and coefficient calculation. Nomograms predicting OS and CSS were generated.

Results

Of the 2,417 eligible patients, 1,692 and 725 were randomly allocated to the training and validation cohorts. The median age (Interquartile range) was 66 (56–78) and 65 (55–76) for the two cohorts, respectively. Our models had larger net benefits in predicting the survival of VC patients than the American Joint Committee on Cancer stage, presenting great discrimination ability and excellent agreement between the expected and observed events. The performance metrics of our models were calculated in three cohorts: the training cohort, complete cases of the validation cohort, and the imputed validation cohort. For the OS model in the three cohorts, the C-statistics were 0.761, 0.752, and 0.743. The slopes of the calibration plots were 1.017, 1.005, and 0.959. The 3- and 5-year AUCs were 0.795 and 0.810, 0.768 and 0.771, and 0.770 and 0.767, respectively. For the CSS model in the three cohorts, the C-statistics were 0.775, 0.758, and 0.755. The slopes were 1.021, 0.939, and 0.977. And the 3- and 5-year AUCs were 0.797 and 0.793, 0.786 and 0.788, and 0.757 and 0.757, respectively.

Conclusion

We were the first to develop and validate exemplary survival prediction models for VC patients and generate corresponding nomograms that allow for individualized survival prediction and could assist clinicians in performing risk-adapted follow-up and treatment.

Factors that affect survival in vaginal cancer: a seer analysis

This study aimed to investigate the factors that affect survival in vaginal cancer by means of a large population-based database that had been monitored over a 42 year period (1975-2017). It was investigated which factors were most predictive in survival. This study evaluated the factors that affect survival in primary vaginal cancer as one of the rarest gynaecological cancers. Relationships were explored between survival and age and race of patient, in situ/invasive behaviour of tumour, histological type, stage, grade, surgical treatment, and year of diagnosis. Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more predictive of mortality in older patients and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery.At the end of this study, an estimation model was developed for 10-year survival in vaginal cancer and software was created for the model. Impact StatementWhat is already known on this subject? Primary vaginal cancer is very rare, accounting for 2% of female genital tract malignancies. Due to its low incidence and difficulty of its final diagnosis, vaginal cancer has the least amount of data among all female genital tract malignancies. It is difficult for clinicians to estimate the survival with already limited data on vaginal cancer in the literature.What do the results of this study add? Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more effective in mortality with older age and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery.What are the implications of these findings for clinical practice and/or further research? It is anticipated that such studies will contribute to the transformation of societal data collection methods into a prospective nature and lead the way for stronger survival estimation models to be developed in days to come.

Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study

Background

The efficacy of radiotherapy plus chemotherapy (RTCT) versus radiotherapy alone (RT) in the treatment of primary vaginal carcinoma has been controversial. We aimed to evaluate the up-to-date efficacy of RTCT on primary vaginal carcinoma in a real-world cohort.

Methods

We performed a retrospective analysis in patients with primary vaginal carcinoma retrieved from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Kaplan-Meier survival curves were plotted and compared by the log-rank test. Inverse probability weighting (IPW)-adjusted multivariate Cox proportional hazards and Fine-Gray competing-risk model was applied.

Results

Of the 1,813 qualified patients with primary vaginal carcinoma from 2004 to 2016, 1,137 underwent RTCT and 676 underwent RT. The median survival time was 34 months for the RT group and 63 months for the RTCT group. RTCT was significantly associated with improved overall survival (unadjusted HR = 0.71, 95% CI 0.62-0.82, p < 0.001; adjusted HR = 0.73, 95% CI 0.63-0.84, p < 0.001) and cancer-specific survival (unadjusted sHR = 0.81, 95% CI 0.69-0.95, p = 0.012; adjusted sHR = 0.81, 95% CI 0.69-0.96, p = 0.016). Age, histological type, tumor size, surgery, and FIGO stage were all independent prognostic factors for survival (p < 0.05 for all). Subgroup analysis demonstrated that RTCT was significantly associated with better survival in most subgroups, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I. Moreover, sensitivity analysis did not alter the beneficial effects of RTCT.

Conclusion

RTCT is significantly correlated with prolonged survival in patients with primary vaginal carcinoma. RTCT should be applied to most patients with primary vaginal carcinoma instead of RT alone, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I.

Survival and prognostic factors in primary vaginal cancer: an analysis of 2004-2014 SEER data

Background

Primary vaginal cancer (PVC) is a rare gynecological malignant tumor and we know little about its survival and prognostic factors. The purpose of this study is to evaluate the potential survival and prognostic factors in women with PVC.

Methods

We used data from the Surveillance, Epidemiology, and End Results (SEER) program to identify 1,781 women who had been diagnosed with PVC between 2004 and 2014. Univariate and multivariable analyses were used to evaluate cases survival and prognostic factors. A stratified analysis was further performed to analyze the prognostic factors in each stage.

Results

There were 20.0% of patients aged ≥80 years and most women were married, 42.1%, and then widowed, 25.2%. The histology types include squamous (74.5%), adenocarcinoma (16.7%), melanoma (3.3%) and sarcoma (1.5%). Five-year cause-specific survival (CSS) rates were overall: 57.8%, Stage I: 76.4%, Stage II: 61.9%, Stage III: 53.3% and Stage IV: 22.5%. Univariate analysis showed that age, marital status, race, pathological grading, histology, TNM stage, tumor size, surgery and radiation were related to prognosis. The 5-year CSS of married women is 64.4%, while those of divorced/separated and widowed are 56.6% and 44.1%, respectively. Multivariate analysis indicated that age, histology, TNM stage, tumor size, surgery and radiation were independent prognostic factors. The elderly (≥80) cases and those with melanoma were correlated to worse prognosis at any stage of PVC. As tumor stage progressed, both of the ≥80 years old patients and the melanoma cases showed a decline tendency of mortality risk.

Conclusions

PVC is a rare gynecological malignant tumor and more likely to occur among older women. Squamous cell carcinoma is the most frequently observed histological type, while melanoma is extremely rare. Age, histology, TNM stage, tumor size, surgery and radiation are independent prognostic factors. Although marital status does not affect survival rates, married women are likely to live longer than widowed and divorced/separated cases. Age ≥80 years seems to be an important cut point in the survival of vaginal cancer. Older age (≥80 years) and melanoma have greater influences on mortality risk in early-stage disease.

Survival benefit of vaginectomy compared to local tumor excision in women with FIGO stage I and II primary vaginal carcinoma: a SEER study

PURPOSE

The effectiveness of vaginectomy compared to that of local tumor excision (LTE) for the International Federation of Gynecology and Obstetrics (FIGO) stage I and II vaginal carcinoma is unclear. We aimed to clarify if the effectiveness of vaginectomy is comparable to that of LTE in the real world.

METHODS

We retrospectively evaluated data of patients with primary vaginal carcinoma registered in the Surveillance, Epidemiology, and End Results Program (SEER) database from 2004 to 2016. The multivariate Cox proportional hazards models and Fine-Gray competing risk models were used to estimate the overall survival (OS) and disease-specific survival (DSS) after propensity score matching.

RESULTS

Of the 533 patients with FIGO stage I and II primary vaginal carcinoma, 243 and 290 patients were treated with vaginectomy and LTE, respectively. Vaginectomy was significantly associated with improved OS [unadjusted hazard ratio (HR) = 0.70, 95% confidence interval (CI) 0.53-0.95, P = 0.020; adjusted HR = 0.63, 95% CI 0.46-0.87, P = 0.005] and DSS [unadjusted subdistribution HR (sHR) = 0.75, 95% CI 0.52-1.07, P = 0.115; adjusted sHR = 0.65, 95% CI 0.44-0.97, P = 0.036]. Age, marital status, histology type, FIGO stage, chemotherapy, and lymph node metastases were significant prognostic factors of survival. Moreover, radiotherapy did not influence the effectiveness of vaginectomy. Subgroup and sensitivity analysis confirmed the consistent beneficial effectiveness of vaginectomy.

CONCLUSION

Compared with LTE, vaginectomy results in significantly prolonged survival in patients with FIGO stage I and II primary vaginal carcinoma. Thus, it can be the preferred treatment for FIGO I and II vaginal cancer regardless of radiotherapy status.