title: Successful centralisation of patients with vulvar carcinoma: a population-based study in The Netherlands.
abstract: BACKGROUND
  In general, centralisation of care for patients with rare malignancies is advised in order to improve outcome with respect to prognosis and treatment related morbidity. Therefore, centralisation of women with vulvar squamous cell carcinoma (SCC), which is an extremely rare tumour, has been advocated by the national guidelines of the Dutch Society of Obstetrics and Gynaecology in 2000. The objective of this study was to determine whether this advice has been adapted and has led to improved survival.
  
  
  METHODS
  All patients diagnosed with vulvar malignancies between 1989 and 2008 in the Eastern part of the Netherlands were retrieved from the population-based cancer registry held by the Comprehensive Cancer Centre, The Netherlands. Patient- and tumour characteristics and vital status until January 2011 were retrieved. Data of patients diagnosed in two periods (before and after release of the guideline; 1989-1999 and 2000-2008) were compared. Relative survival rates were calculated as a good approximation of cause-specific survival.
  
  
  RESULTS
  A total number of 382 patients with vulvar SCC with invasion > 1mm, who had an indication for groin surgery, were included in the analysis. In the first decade 62% (123 of 198 patients) were treated in a specialised oncology centre, which increased to 93% (172 of 184 patients) in the more recent period. Overall, the 5 year relative survival improved slightly from 69% (95% confidence interval (CI) 60-77%) to 75% (95% CI 65-83%). After adjustment for age and stage, being treated in a specialised oncology centre was an independent prognostic factor for survival.
  
  
  CONCLUSIONS
  Centralisation of care for vulvar SCC patients has been well adopted in the Eastern part of the Netherlands. Being treated in a specialised oncology centre was associated with a better survival after adjustment for age and stage.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. l.vandeneinden@obgyn.umcn.nl
authors.forename: Loes C G
authors.initials: LC
authors.lastname: van den Einden
authors.forename: Katja K H
authors.initials: KK
authors.lastname: Aben
authors.forename: Leon F A G
authors.initials: LF
authors.lastname: Massuger
authors.forename: Dick Johan
authors.initials: DJ
authors.lastname: van Spronsen
authors.forename: Joanne A
authors.initials: JA
authors.lastname: de Hullu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D011159:Population Surveillance; D014846:Vulvar Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D055815:Young Adult