Patient, tumor, and health system factors affecting groin node dissection rates in vulvar carcinoma: A population-based cohort study

Lilian T. Gien, Rinku Sutradhar, Gillian Thomas, Allan Covens, Laurie Elit, Eileen Rakovitch, Anthony Fyles, Mahmoud A. Khalifa, Ying Liu, Lisa Barbera

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objective To determine the rate of groin node dissection (GND) for invasive vulvar carcinoma in a population-based cohort, and the patient, tumor, or health system factors associated with having this procedure. Methods This retrospective population-based cohort includes all cases of invasive squamous cell carcinoma identified in the provincial cancer registry from 1998 to 2007. Chart abstraction was completed for all clinical and pathologic factors. Descriptive analyses with chi-squared tests were used for comparing proportions between patient groups. Multivariable logistic regression analysis was implemented to determine factors associated with having a GND. Results Data was collected for 1109 patients; 1038 patients were included in this analysis. 647 (62%) had a GND as part of primary management of their vulvar cancer, while 391 (38%) did not. When those with depth of invasion ≤ 1 mm and no GND were removed, the GND rate increased to 68%. Reasons for no GND included age, obesity, advanced disease, or comorbidities. Factors significantly associated with omission of GND were increasing age (OR 0.98, CI 0.97-0.99), severe comorbidities (OR 0.57, CI 0.42-0.78), lower income quintile (OR 0.71, CI 0.54-0.95), and surgeon type (non-gynecologic oncologist vs gynecologic oncologist) (OR 0.43, CI 0.22-0.85), whereas depth of invasion > 1 mm was significantly associated with having a GND (OR 2.75, CI 2.08-3.62). Conclusion This population-based cohort demonstrates 32% of invasive vulvar cancer patients did not have a GND at initial management. Vulvar cancer patients should be evaluated by clinicians with expertise in this rare disease to ensure that a GND is completed when feasible.

Original languageEnglish (US)
Pages (from-to)465-470
Number of pages6
JournalGynecologic oncology
Volume139
Issue number3
DOIs
StatePublished - Dec 1 2015

Bibliographical note

Funding Information:
This study was funded by the Canadian Cancer Society Research Institute , the Ontario Institute for Cancer Research (OICR)/Cancer Care Ontario (CCO) Health Services Research (HSR) Program , and the Gynecologic Disease Site at Odette Cancer Centre . This study was supported by the Institute for Clinical Evaluative Sciences (ICES) , which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC) . The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the MOHLTC is intended or should be inferred.

Keywords

  • Factors
  • Groin
  • Management
  • Nodes
  • Population
  • Vulvar cancer

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