Journal article
Impact of adjuvant chemotherapy with radiation for node-positive vulvar cancer: A National Cancer Data Base (NCDB) analysis
Gynecologic oncology, v 137(3), pp 365-372
01 Jun 2015
PMID: 25868965
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
For node-positive vulvar cancer, adjuvant radiotherapy has an established benefit, whereas the impact of chemotherapy is unknown. A National Cancer Data Base (NCDB) analysis was conducted to determine patterns of care and evaluate the survival impact of adjuvant chemotherapy.
The NCDB was queried for vulvar cancer patients diagnosed from 1998–2011 who underwent extirpative surgery with confirmed inguinal nodal involvement treated with adjuvant radiotherapy. Patients with inadequate follow-up or non-squamous histologies were excluded. Chi-square test, logistic regression analysis, log-rank test and multivariable Cox proportional regression modeling with adjustment using propensity score with inverse probability of treatment weights (IPTW) were conducted to establish factors associated with utilization and survival.
A total of 1797 patients were identified: 26.3% received adjuvant chemotherapy and 76.6% had 1–3 involved lymph nodes. Adoption of adjuvant chemotherapy significantly increased over time, from 10.8% in 1998 to 41.0% in 2006 (p<0.001). Lower utilization was seen in older patients, Northeast or Southern facilities, and patients with more extensive nodal dissection, whereas greater number of involved nodes, stage IVA disease and positive surgical margins led to a higher probability of receiving chemotherapy. Unadjusted median survival without and with adjuvant chemotherapy was 29.7months and 44.0months (p=0.001). On IPTW-adjusted Cox proportional regression modeling, delivery of adjuvant chemotherapy resulted in a 38% reduction in the risk of death (HR 0.62, 95% CI 0.48–0.79, p<0.001).
In a large population-based analysis, adjuvant chemotherapy resulted in a significant reduction in mortality risk for node-positive vulvar cancer patients who received adjuvant radiotherapy.
•Utilization of adjuvant chemotherapy for node-positive vulvar cancer is increasing.•Adjuvant chemotherapy improved survival following surgery and radiation.
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Details
- Title
- Impact of adjuvant chemotherapy with radiation for node-positive vulvar cancer: A National Cancer Data Base (NCDB) analysis
- Creators
- Beant S. Gill - UPMC Hillman Cancer CenterMark E. Bernard - UPMC Hillman Cancer CenterJeff F. Lin - Magee-Womens HospitalGoundappa K. Balasubramani - University of PittsburghMalolan S. Rajagopalan - UPMC Hillman Cancer CenterPaniti Sukumvanich - University of Pittsburgh Medical CenterThomas C. Krivak - Western Pennsylvania HospitalAlexander B. Olawaiye - Magee-Womens HospitalJoseph L. Kelley - Magee-Womens HospitalSushil Beriwal - UPMC Hillman Cancer Center
- Publication Details
- Gynecologic oncology, v 137(3), pp 365-372
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000355779000002
- Scopus ID
- 2-s2.0-84930042071
- Other Identifier
- 991021897283104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology
- Oncology