Primary treatment and relative survival by stage and age in vaginal carcinoma: a population-based SweGCG study

Abstract

Background and purpose This study aimed to investigate treatment patterns and survival outcomes in population-based data describing treatment and survival of primary vaginal carcinoma (VC) in a routine clinical setting, stratified by age group and stage. Methods This nationwide, population-based study included women diagnosed with epithelial VC between 2011 and 2020, registered in the Swedish Quality Register for Gynecologic Cancer. Five-year relative survival (RS) was estimated using the Pohar Perme method. The excess mortality rate ratio (EMRR) was assessed by Poisson regression. Results In total, 252 women were identified, 29% were aged ≥ 80 years. The median follow-up time was 7.5 years. The most common stages were I and II (26% each). Definitive radiotherapy, with or without chemotherapy, was administered to 59% of patients. Among women with stage I, 48% underwent primary surgery and 29% received adjuvant radiotherapy. Treatment patterns differed across age groups. Among women aged ≥ 80 years, staging was omitted in 18%, and in stage I disease 25% received palliative therapy. None of the irradiated women aged ≥ 80 years received chemoradiotherapy, compared to all women aged 20–59 years. The overall 5-year RS for stages I–IV was 51% (95% confidence interval [CI] 43–58). In stages I–II, the 5-year RS was 28% among women aged ≥80 years and 84% among those aged < 60 years (EMRR of 5.2; 95% CI 1.7–15.6). Interpretation Primary treatment of vaginal cancer in Sweden generally followed international guidelines, except among women aged ≥ 80 years. The markedly poorer RS in this age group suggests both diagnostic and therapeutic compromises.