title: Trends in surgery and outcomes of squamous cell vulvar cancer patients over a 16-year period (1998-2013): a population-based analysis.
abstract: OBJECTIVE
  The objective was to identify trends in surgery and the outcomes of squamous cell vulvar cancer in a population-based setting.
  
  
  METHODS
  A total of 1113 patients with squamous cell vulvar cancer diagnosed between 1998 and 2013 in the catchment area of the Munich Cancer Registry (population approximately 4.6 million) were analysed. Trends in prognostic factors and treatment were examined by comparing patients diagnosed between 1998 and 2008 with those diagnosed between 2009 and 2013. Cumulative incidence was used to calculate time to local (LR) and lymph node recurrence (LNR). Survival was analysed by the Kaplan-Meier method, calculation of relative survival (RS), and a Cox model.
  
  
  RESULTS
  The high median age at diagnosis of 75 years did not change significantly over time. In addition, no changes in the subsite of tumour or grading were noted. A decrease in patients undergoing complete vulvectomy from 27.7 to 17.8 % (p < 0.001) as well as an increase in the use of sentinel lymph node biopsy from 11.4 to 39.1 % (p < 0.001) was observed. However, time to LR (from 19 to 19 %) and time to LNR (from 9 to 9 %) as well as 5-year overall survival (from 55 to 55 %) and RS (from 66 to 63 %) were not significantly altered. After adjustment for prognostic factors, less radical locoregional surgery had no influence on survival.
  
  
  CONCLUSIONS
  Less radical locoregional surgery in vulvar cancer is increasingly implemented. Locoregional recurrence and survival have not been affected by these changes and are likely accompanied by an improvement in quality of life.
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), University Hospital of Munich, Klinikum Großhadern, Ludwig-Maximilians-Universität (LMU), Marchioninistr. 15, 81377, Munich, Germany. rottmann@ibe.med.uni-muenchen.de.
authors.forename: M
authors.initials: M
authors.lastname: Rottmann
authors.affiliation: Department of Gynaecology, RoMed Hospital Rosenheim, Rosenheim, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Beck
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Burges
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Dannecker
authors.affiliation: Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kiechle
authors.affiliation: Department of Pathology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Mayr
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), University Hospital of Munich, Klinikum Großhadern, Ludwig-Maximilians-Universität (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schlesinger-Raab
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), University Hospital of Munich, Klinikum Großhadern, Ludwig-Maximilians-Universität (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Schubert-Fritschle
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), University Hospital of Munich, Klinikum Großhadern, Ludwig-Maximilians-Universität (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Engel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*
keywords: Cancer epidemiology; Cancer registry; Surgery; Survival; Vulvar cancer