Survival Outcome of Patients with Vulvar Malignancy Treated at a Tertiary Care Cancer Centre: A Cohort Study

Introduction: Vulvar malignancy is a rare gynaecological malignancy and understanding the determinants of vulvar cancer outcomes is essential for improving patient care and guiding future research in this field. The management of vulvar malignancy ranges from wide local excision to radical vulvectomy for early-stage and advanced disease managed by external beam radiotherapy with concurrent chemotherapy. Aim: To determine the Overall Survival (OS) and Disease-Free Survival (DFS) among patients with vulvar cancer. Materials and Methods: This was a retrospective cohort study of patients with vulvar malignancy who underwent treatment over a 10-year period (from January 2011 to December 2020) at a tertiary cancer centre in South India, Department of Gynaec Oncology, Malabar Cancer Centre (Postgraduate Institute of Oncology Sciences and Research), Thalassery, Kerala, India. Details such as age, Performance Status (PS), tumour histology, stage, intent of treatment, type of treatment and recurrence were collected from case records. The Kaplan-Meier test was used to estimate OS and DFS. Results: A total of 29 patients were analysed; the mean age was 67.03 years (ranging from 48 to 93 years). A total of 3 (10.34%) patients were premenopausal and 26 (89.66%) were postmenopausal. A total of 24 (82.8%) cases were squamous cell carcinoma and 3 (10.34%) were adenocarcinoma. A total of 12 (41.4%) patients received curative intent treatment, 13 (44.8%) received palliative intent treatment and 4 (13.79%) received best supportive care. The five-year OS was 28% for all stages, with a median OS of 23.16 months. The five-year OS for curative intent patients was 50%, while for palliative intent patients, it was 15.4%. Out of the nine cases that underwent surgery, 1 (11.1%) had local recurrence, 1 (11.1%) had regional nodal recurrence and one had a distant site recurrence. The estimated five-year DFS was 63.5%. Conclusion: The present study highlights that early-stage diagnosis and curative intent treatment significantly improve survival outcomes in vulvar cancer. Patients treated with curative intent had a five-year OS of 50% and a DFS of 63.5%, compared to a 15.4% OS in palliative cases. Advanced stage at presentation and older age were associated with poorer prognosis. These findings underscore the need for early detection and individualised, multimodal treatment strategies to optimise outcomes.