Management and outcomes for elderly women with vulvar cancer over time.

Objective To examine changes over time in survival and treatment for women diagnosed with vulvar squamous cell carcinoma included in the Surveillance, Epidemiology, and End Results ( SEER) Program. Design Retrospective analysis. Setting USA, data obtained from the SEER Program for 1988-2009. Population Women with vulvar squamous cell carcinoma. Methods Women were stratified by age: <50, 50-64, 65-79, and ≥80 years. Differences in survival and treatment patterns were analysed between age groups. Multivariate logistic regression models were constructed to examine treatment patterns. Kaplan-Meier and Cox proportional hazards survival methods were used to assess survival. Main outcome measures Vital status from the date of diagnosis until death, censoring or last follow-up. Results The final study group consisted of 8553 women, 1806 (21.12%) <50 years, 2141 (25.03%) 50-64 years, 2585 (30.22%) 65-79 years, and 2021 (23.63%) >80 years old. After adjusting for patient and tumour characteristics, older women were less likely to have surgery and more likely to receive radiotherapy. Compared with women under 50 years, women 50-64 had a two-fold higher risk of death ( HR 1.91, 95% CI 1.55-2.34); those 65-79 years had a four-fold higher risk of death ( HR 4.01, 95% CI 3.32-4.82), and those ≥80 years had a seven-fold higher risk of death ( HR 6.98, 95% CI 5.77-8.46). These trends stayed relatively constant over the time periods studied. Conclusions Women over 50 years are at a higher risk of vulvar cancer-specific mortality, which increases with age. These trends stayed relatively constant over the time periods studied. [ABSTRACT FROM AUTHOR]