title: Trends in of late-stage squamous cell vulvar carcinomas: analysis of the surveillance, epidemiology, and end results (SEER) database.
abstract: OBJECTIVE
  To describe the trends in the rate, treatment, and survival of late-stage vulvar carcinomas (LSVCs) over a 20-year period in the United States.
  
  
  METHODS
  Demographic, pathologic, treatment, and survival data were collected from the Surveillance, Epidemiology, and End Results registry between 1988 and 2007. Trends concerning the rate of LSVC (International Federation of Gynecology and Obstetrics [FIGO] stages III and IV), its management, and outcome were studied. Five-year overall and disease-specific survival rates were calculated.
  
  
  RESULTS
  The rate of LSVC (32.4%) as compared with early-stage disease (67.6%) did not change significantly from 1988 to 2007 (P = 0.59). Of the 2630 patients with LSVC, the median age at diagnosis was 72 years, with 88.5% of them being white. Surgery and radiation therapy were performed in 73.8% and 60.6% of cases, respectively, with 37% of the patients having no lymph node dissection. A significant trend toward removing fewer lymph nodes (P = 0.02) and offering more radiation therapy (P = 0.02) has been observed across the study period. Five-year overall and disease-specific survival rates did not change (P = 0.44 and P =0.26, respectively) from 1988 to 2007. On multivariate analysis, node positivity (hazard ratio, 3.12 [95% confidence interval, 2.30-4.24]) and surgery (hazard ratio, 0.41 [95% confidence interval, 0.24-0.69]) were found to be the 2 most predictive variables for cancer mortality, followed by age and tumor size.
  
  
  CONCLUSIONS
  Less extensive surgery and more radiation therapy did not compromise survival of LSVC over the 20-year period.
authors.affiliation: Obstetrics and Gynecology Department, Tenon Hospital, 4 Rue de la Chine, Paris, France.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Ramanah
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Lesieur
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
authors.forename: Emile
authors.initials: E
authors.lastname: Darai
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014846:Vulvar Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology