EP412/#708 Vulvar cancer: patterns of care in a tertiary centre in India and implications of the revised FIGO staging (2021)

Objectives

To evaluate the clinical profile and management of vulval cancer in India and assess the impact of the revised FIGO staging on outcomes.

Methods

This retrospective observational study reviewed hospital records of 82 biopsy-proven vulval cancers. FIGO staging was assigned by 2009 and 2021 classifications. Survival function was calculated using Kaplan Meier and multivariable analysis using Cox proportional hazards model.

Results

The median age of patients was 61 (24–92) years. Primary therapy was surgery in 73.2%; definitive radiotherapy±chemotherapy in 10.9%; neoadjuvant radiotherapy and surgery in 4.9% and palliation in 10.9% cases. Adjuvant RT was administered in 31.7% (26/82) cases. Disease-specific recurrence and mortality rates were 32.9%(26/82) and 30.5%(25/82), respectively. Median DFS and OS were 17(IQR 1–36) and 27(IQR 9–52) months, respectively. With 2021 staging, stage shift was observed in 18% cases of advanced vulval cancer (3 upstaged from IIIA to IIIB; 5 downstaged from IVA to IIIA). The 3-year DFS was reduced for stage IIIA from 71.4% to 67%, and 5-year-DFS from 71.4% to 33%. The 3-year-OS reduced from 100% to 50%, and 5-year-OS from 83% to 33%. In Stage IVA 3-year-OS reduced from 23% to 20%, 5-year-OS from 11% to 0%, and increased for stage IIIB (3-year-DFS from 60% to 69%, 5-year-DFS from 20% to 34%; 3-year-OS from 46% to 56.7%, 5-year-OS from 35% to 47.3%).

Conclusions

There is a wide variety of patterns of care in LMICs. The FIGO 2021 staging is simpler and easier to use. Nearly one-fifth of advanced vulvar cancer were restaged. There was better correlation with outcomes.