Prognostic Factors and Quality of Life in Vulvar Cancer Patients: 12-Year Results from a Eastern European Center

<b>Objectives:</b> Despite the relatively high incidence of vulvar cancer, there is a noticeable lack of studies in Romania and other Eastern European countries focused on evaluating the long-term oncological outcomes and Quality of Life (QoL) for patients with this condition. <b>Methods:</b> A total of 91 patients were included in the study. The first objective was to evaluate the 5-year overall survival (OS) in patients with vulvar cancer at International Federation of Gynecology and Obstetrics (FIGO) stages IA-IVA who underwent surgery, ±adjuvant radiotherapy (RT). Additionally, the study aimed to identify prognostic factors that could either positively or negatively influence survival outcomes in these patients. The second objective was to assess the QoL, conducted using validated questionnaires issued by the European Organization for Research and Treatment of Cancer, specifically the QLQ-CX30 and QLQ-VU34. <b>Results:</b> The patients had an average age of 67.7 years (38-91). At the time of assessment, 51.6% of the patients were alive. Additionally, the 5-year OS was reported at 45%. The multivariate analysis indicated that age ≤ 50 years (<i>p</i> < 0.03), FIGO stage IB (<i>p</i> < 0.007), and tumor differentiation grade I (<i>p</i> < 0.01) were associated with improved survival rates. Conversely, age > 80 years (<i>p</i> < 0.05), FIGO stages IIIB (<i>p</i> < 0.01) and IIIC (<i>p</i> < 0.06), tumor size > 5 cm (<i>p</i> < 0.02), positive resection margins (<i>p</i> < 0.03), lymph node metastasis (<i>p</i> < 0.06), and pelvic exenteration (<i>p</i> < 0.002) were identified as independent negative prognostic factors. Of the 47 living patients, 32 completed the QoL questionnaires. The respondents reported a decent overall QoL score of 65.3. However, treatment-specific symptoms, such as vulvar scarring, vulvar swelling, groin lymphedema, and leg lymphedema, had a negative impact on QoL. Consequently, functional symptoms like fatigue, pain, and sleep disturbances persisted, leading to a body image perception score of 33.7 on a scale from 0 to 100. <b>Conclusions:</b> This study highlights decent OS and QoL outcomes. It is important to note that vulvar cancer primarily affects older women. In this study, 51.6% of patients were over 70 years old at the time of surgery. Consequently, the 5-year OS of 45% could not be attributed solely to oncological factors, as most of these patients did not die from recurrences but rather from associated comorbidities. The findings of this study provide a foundation for future randomized controlled trials aimed at further enhancing vulvar cancer patients' care and outcomes.