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Huang J, Chan SC, Pang WS, Mak FY, Fung YC, Lok V, Zhang L, Lin X, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Incidence distributions, risk factors and trends of vaginal cancer: A global population-based study. BJOG 2024. [PMID: 38924674 DOI: 10.1111/1471-0528.17887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This study aimed to investigate the incidence, risk factors and trends for vaginal cancer. DESIGN Retrospective observational design. SETTING Data were collected from multiple sources, including the Global Cancer Observatory, Cancer Incidence in Five Continents Plus, Global Burden of Disease, World Bank and the United Nations. POPULATION Individuals diagnosed with vaginal cancer. METHODS The study collected data on vaginal cancer from the specified sources. The age-standardised rate (ASR) of vaginal cancer was calculated for different regions and age groups. Multivariable and univariable linear regression analyses were performed to examine the associations between risk factors and the incidence of vaginal cancer. Trend analysis was conducted using joinpoint regression analysis, and the average annual percentage change (AAPC) was calculated to quantify the temporal trend. MAIN OUTCOME MEASURES The main outcome measures of the study were the incidence of vaginal cancer, risk factors associated with the disease and the trend of its incidence over time. RESULTS There were 17 908 newly reported cases of vaginal cancer (ASR = 0.36, 95% CI 0.30-0.44) in 2020, with the highest ASRs reported in South-Central Asia and Southern Africa. Risk factors associated with a higher incidence of vaginal cancer included a higher prevalence of unsafe sex and human immunodeficiency virus (HIV) infection. The temporal trend showed an overall rising incidence globally, with Iceland (AAPC = 29.56, 95% CI 12.12-49.71), Chile (AAPC = 22.83, 95% CI 13.20-33.27), Bahrain (AAPC = 22.05, 95% CI 10.83-34.40) and the UK (AAPC = 1.40, 95% CI 0.41-2.39) demonstrating the most significant rising trends. CONCLUSIONS The significant regional disparities and risk factors associated with vaginal cancer underscore the necessity for targeted interventions and education, particularly in regions with a lower human development index (HDI) and a higher prevalence of human papillomavirus (HPV) infection. The increasing incidence trend emphasises the need for enhanced HPV vaccination rates to prevent the development of vaginal cancer.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Wing Sze Pang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Fung Yu Mak
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yat Ching Fung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou, China
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xu Lin
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | | | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, California, USA
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Kwolek DG, Gerstberger S, Tait S, Qiu JM. Ovarian, Uterine, and Vulvovaginal Cancers: Screening, Treatment Overview, and Prognosis. Med Clin North Am 2023; 107:329-355. [PMID: 36759101 DOI: 10.1016/j.mcna.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ovarian, uterine, and vulvovaginal cancers affect approximately 96,000 women per year in the United States, resulting in approximately 29,000 deaths annually. Routine screening protocols do not detect these malignancies; thus, the recognition of risk factors and evaluation of worrisome symptoms are essential for early detection and improved prognoses. Treatment is managed by gynecologic oncologists, and often involves a combination of surgery, chemotherapy, and possible radiation treatments. Survivor care is managed by the primary-care clinician: expert attention to the mental, physical, and sexual health of each patient will ensure the best outcomes and quality of life.
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Affiliation(s)
- Deborah Gomez Kwolek
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Stefanie Gerstberger
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sarah Tait
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeanna M Qiu
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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Forner DM. Characteristics and survival of primary vaginal malignancy: an analysis of the German nationwide cancer registry data. J Cancer Res Clin Oncol 2023; 149:1115-1122. [PMID: 35314872 DOI: 10.1007/s00432-022-03982-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vaginal neoplasms are rare. To study the survival of patients depending on tumour characteristics and age, the data from the national cancer registries in Germany were analysed. METHODS In a retrospective analysis, data from 2006 to 2015 on disease stage, survival, and factors that might affect prognosis were analysed. RESULTS Altogether, out of 4004 datasets, 2194 were deemed adequate to be included in the analysis. Overall survival at 5 years (5YSR) and relative survival (5RSR) were 48.6% (95%CI 45.4-52.1%) and 58.7% (95%CI 55.3-61.2%) for carcinomas, but significantly worse at 20.2% (95%CI 8.3-32.0%) and 24.2% (95%CI 16.4-32.0%) for melanomas and 38.3% (95%CI 23.3-53.5%) and 44.4% (95%CI 31.5-56.8%) for sarcomas. 5YSR and 5RSR correlated significantly with FIGO stages (5YSR: 66.9-10.1%; 5RSR: 81.7-11.9%, p = 0.04). Furthermore, survival depended on the absence of LN metastases (5RSR: 59.1% vs. 38.0%, p < 0.001), and the tumour grading had an influence (5RSR: 83.7-52.1%). We also noted that prognosis was worse for older patients ≥75 years (5RSR:51.2%) than for patients <55 years (62.2%) and 55-74 years of age (61.6%). CONCLUSION Unless LN metastases, local advanced tumours and G3 grading are associated with a worse prognosis. Relative survival of older patients decreases, perhaps indicating that treatment compromises have been made.
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Affiliation(s)
- Dirk Michael Forner
- Department of Gynaecology, Gynaecologic Oncology and Obstetrics, Evangelisches Krankenhaus Köln Kalk, Buchforststrasse 2, 51103, Köln, Germany.
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Piechocki M, Koziołek W, Sroka D, Matrejek A, Miziołek P, Saiuk N, Sledzik M, Jaworska A, Bereza K, Pluta E, Banas T. Trends in Incidence and Mortality of Gynecological and Breast Cancers in Poland (1980-2018). Clin Epidemiol 2022; 14:95-114. [PMID: 35115839 PMCID: PMC8800373 DOI: 10.2147/clep.s330081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study aimed to analyze and determine the incidence and mortality trends in gynecological and breast cancers (BCs) in Poland. The gynecological cancers assessed were cervical cancer (CC), corpus uteri cancer (CUC), ovarian cancer (OC), vaginal cancer (VAC), and vulvar cancer (VUC). PATIENTS AND METHODS Data concerning the incidence and mortality for the period of 1980-2018 were obtained from the Polish National Cancer Registry (PNCR). Joinpoint regression analysis was performed to identify trends, which were described using the annual percentage change (APC) and the average annual percent change (AAPC). RESULTS Statistically significant increases were observed in BC incidence (AAPC: 2.3; CI: 1.8 to 2.9; p<0.05), CUC incidence (AAPC: 2.3; CI: 1.9 to 2.7; p<0.05), CUC mortality (AAPC: 0.4; CI: 0.1 to 0.7; p<0.05) and VUC mortality (AAPC: 1.16, CI: 0.1 to 2.2; p<0.05). VAC mortality decreased (AAPC: -3.5, CI: -5.0 to -2.0; p<0.05), as did CC incidence and mortality (AAPC: -2.1, CI: -2.3 to -1.8; p<0.05, AAPC: -2.0, CI: -2.2 to -1.8; p<0.05, respectively). Between 1980 and 1993, OC incidence initially increased and then stabilized (AAPC: 0.9; CI: 0.7 to 1.1; p<0.05). After 2007, OC mortality decreased (AAPC: 0.0; CI: -0.2 to 0.2; p=0.8). Trends in VUC and VAC incidence and BC mortality were not statistically significant. CONCLUSION The results of this study showed a significant increase in OC, CUC, and BC incidence, and a decrease in the incidence of CC and VAC. The VUC trends were stable. Mortality trends for BC initially fluctuated and, since 2010, has begun to increase. Throughout the observed period, mortality due to VUC and CUC increased, whereas decreased among patients with CC. OC mortality was stable, but not significant. Furthermore, the study showed a correlation between age group and rate of incidence and mortality of each assessed cancer.
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Affiliation(s)
- Marcin Piechocki
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Koziołek
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Damian Sroka
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Matrejek
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Miziołek
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Nazarii Saiuk
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Sledzik
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Adriana Jaworska
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Bereza
- Department of Mother and Child Health;Faculty of Health Sciences;Institute of Nursing and Midwifery;Jagiellonian University Medical College, Krakow, Poland
| | - Elzbieta Pluta
- Department of Radiotherapy, Maria Sklodowska–Curie Institute - Oncology Centre, Krakow, Poland
| | - Tomasz Banas
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
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Huang J, Cai M, Zhu Z. Survival and prognostic factors in primary vaginal cancer: an analysis of 2004-2014 SEER data. Transl Cancer Res 2020; 9:7091-7102. [PMID: 35117314 PMCID: PMC8798963 DOI: 10.21037/tcr-20-1825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/14/2020] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Jianqin Huang
- Department of Integrative Medicine, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Meiyu Cai
- Department of Quality Management, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Zhiling Zhu
- Department of Integrative Medicine, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Time trends in the incidence and survival of vaginal squamous cell carcinoma and high-grade vaginal intraepithelial neoplasia in Denmark - A nationwide population-based study. Gynecol Oncol 2020; 158:734-739. [PMID: 32571683 DOI: 10.1016/j.ygyno.2020.05.683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/31/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe trends in incidence of high-grade vaginal intraepithelial neoplasia (VaIN) and vaginal squamous cell carcinoma (SCC) in Denmark. For vaginal SCC, we also examine 5-year relative survival and mortality. METHODS All high-grade VaIN cases diagnosed 1997-2017 and vaginal SCCs during 1978-2017 were identified in two high-quality nationwide registers. Age-standardized incidence rates and average annual percentage change (AAPC) were assessed. For vaginal SCC, 5-year relative survival was calculated, and Cox regression was applied to study the effect of selected characteristics on mortality. RESULTS Altogether, 831 cases of high-grade VaIN and 721 vaginal SCCs were identified. The age-standardized incidence rate of high-grade VaIN showed no clear trend over time. However, when we stratified by age and divided the study period according to HPV vaccine licensure in Denmark (2006), the incidence of high-grade VaIN decreased significantly by 15.6% per year (95% CI: -23.2, -7.3%) after 2007 onwards among the youngest women (<30 years). For vaginal SCC, the incidence decreased from 0.5 (1978-1982) to 0.3 (2013-2017) per 100,000 woman-years. The 5-year relative survival improved over time and was 67.9% (95% CI: 54.9, 84.1%) in the most recent time period. Mortality was significantly associated with calendar year, age, and stage at diagnosis. CONCLUSIONS The overall incidence of high-grade VaIN showed no clear trend over time, but a significant decline was observed in women younger than 30 years after HPV vaccine licensure. The incidence of vaginal SCC was reduced by approximately 50% and survival after vaginal SCC improved over time.
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Romano E, Janati S, Monnier L, Darai É, Bendifallah S, Schlienger M, Touboul E, Rivin Del Campo E, Huguet F. Outcomes of vaginal squamous cell carcinoma of patients treated with radiation therapy: a series of 37 patients from a single expert center. Clin Transl Oncol 2019; 22:1345-1354. [PMID: 31873914 DOI: 10.1007/s12094-019-02264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/08/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim is to assess the outcome of patients treated for vaginal carcinoma with radiation therapy in terms of long-term tolerance and survival. MATERIALS AND METHODS This single-center retrospective study included patients with squamous cell carcinoma of the vagina treated with pelvic external beam radiation therapy (EBRT) with or without vaginal brachytherapy (VB) between 1990 and 2013. RESULTS Thirty-seven patients were included with stage I (24%), II (60%), III (8%), or IV (8%) vaginal tumors. Median age was 66 years (range 27-86 years). Median tumor size was 4 cm (range 0.7-12 cm). Seven patients underwent first intention surgery. The 37 patients received pelvic EBRT (45 Gy) with inguinal irradiation in 57% of cases. Fifteen (41%) received concurrent chemotherapy. Low-dose supplemental VB was performed in 31 patients (84%) (median dose: 20 Gy). Median follow-up was 59 months (range 7-322 months). Four patients (11%) had late grade 3-4 complications. Relapse occurred in 11 patients (30%), five of them locally. The 5-year relapse-free and cancer-specific survival rates were 68% and 76%, respectively. Surgery and concurrent chemotherapy did not seem to have an impact on the course of the disease. CONCLUSION In our experience, pelvic EBRT leads to prolonged survival with acceptable long-term toxicity in patients with squamous cell carcinoma of the vagina.
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Affiliation(s)
- E Romano
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Facult, 4, rue de la Chine, 75020, Paris, France
| | - S Janati
- Department of Radiation Oncology, Cheikh Zaid International University Hospital, Rabat, Morocco
| | - L Monnier
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Facult, 4, rue de la Chine, 75020, Paris, France
| | - É Darai
- Department of Obstetric Gynecology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, UMRS-938, Paris, France
| | - S Bendifallah
- Department of Obstetric Gynecology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, UMRS-938, Paris, France
| | - M Schlienger
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Facult, 4, rue de la Chine, 75020, Paris, France
| | - E Touboul
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Facult, 4, rue de la Chine, 75020, Paris, France
| | - E Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Facult, 4, rue de la Chine, 75020, Paris, France
| | - F Huguet
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Facult, 4, rue de la Chine, 75020, Paris, France.
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