Patient, tumor, and health system factors affecting groin node dissection rates in vulvar carcinoma: A population-based cohort study.
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 ≤1mm 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 >1mm was significantly associated with having a GND (OR 2.75, CI 2.08-3.62).


CONCLUSIONS
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.
Division of Gynecologic Oncology, Odette Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: lilian.gien@sunnybrook.ca.
Lilian T
LT
Gien
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Rinku
R
Sutradhar
University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada.
Gillian
G
Thomas
Division of Gynecologic Oncology, Odette Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
Allan
A
Covens
Division of Gynecologic Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.
Laurie
L
Elit
University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada.
Eileen
E
Rakovitch
University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Anthony
A
Fyles
Department of Anatomic Pathology, University of Minnesota, Minneapolis, MN, United States.
Mahmoud A
MA
Khalifa
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Ying
Y
Liu
University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada.
Lisa
L
Barbera
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007182:Income; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009765:Obesity / Q000150:complications; D012042:Registries; D012189:Retrospective Studies; D013043:Specialties, Surgical / Q000706:statistics & numerical data; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery*
Factors; Groin; Management; Nodes; Population; Vulvar cancer