Trends in the incidence and mortality of vulvar cancer in Australia, and a 29-year overview of management at the Royal Hospital for Women, Sydney [thesis]

Ellen Barlow
Aims: This vulvar cancer thesis had four major aims. To: (i) analyse incidence and mortality trends in Australian women over the years from 1982 to 2011, (ii) investigate the independent prognostic significance of HPV, p16 and p53 status, (iii) determine the incidence of, and risk factors for morbidity following groin node dissection, and (iv) explore the pattern of local recurrences and determine their relationship with the extent of the histopathological margin. Methods: Four studies were
more » ... ormed. (i) Australian population-based vulvar cancer data were analysed for changes in age-standardized incidence and mortality rates. Subsequently, data collected over a 29-year period from the database of a single-institution were analysed in three studies. (ii) immunohistochemistry was used to determine p53 and p16 status, and HPV status was determined by PCR detection of HPV DNA in 119 patients, (iii) clinical and histopathological data for 333 patients (525 groins) treated with groin node dissection were retrospectively analysed for post-operative morbidity, and (iv) data on 345 patients treated primarily with surgery were retrospectively analysed for risk factors associated with local recurrence. Results: (i) vulvar cancer incidence was significantly increasing in women under 60 years and mortality decreasing in women over 60 years, (ii) p16, p53 and HPV DNA status were not independent prognostic factors, (iii) the number of lymph nodes resected was the only factor significantly associated with all complications, and (iv) primary site recurrences were increased in patients with histopathological margins < 8mm. Treatment of patients with sub-optimal margins decreased the risk of recurrence. Conclusions: (i) Vulvar cancer incidence has increased by more than 80% in women younger than 60 years in Australia, consistent with increased exposure to the human papillomavirus in cohorts of females born after 1950, (ii) vulvar cancer treatment decisions should continue to be based on clinical indicators rather than on p16 or [...]
doi:10.26190/unsworks/22697 fatcat:iatnwevbbjauxgxapq7ncaj36y