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Observational Study
. 2021 Oct;31(10):1328-1334.
doi: 10.1136/ijgc-2021-002728. Epub 2021 Sep 7.

Vulvar cancer in Botswana in women with and without HIV infection: patterns of treatment and survival outcomes

Emily MacDuffie #  1 , Sruthi Sakamuri #  2 , Rebecca Luckett  3   4   5   6 , Qiao Wang  7 , Memory Bvochara-Nsingo  8 , Barati Monare  9 , Lisa Bazzett-Matabele  5   6   10 , Thabo Moloi  6 , Tlotlo Ralefala  6 , Doreen Ramogola-Masire  2   5 , Sanghyuk S Shin  7 , Nicola M Zetola  1   9 , Surbhi Grover  11   6   9   12
Affiliations
Observational Study

Vulvar cancer in Botswana in women with and without HIV infection: patterns of treatment and survival outcomes

Emily MacDuffie et al. Int J Gynecol Cancer. 2021 Oct.

Abstract

Objectives: Vulvar cancer is a rare gynecological malignancy. However, the incidence of human papillomavirus (HPV)-associated vulvar disease is increasing, particularly in low- and middle-income countries. HIV infection is associated with an increased risk of HPV-associated vulvar cancer. We evaluated treatment patterns and survival outcomes in a cohort of vulvar cancer patients in Botswana. The primary objective of this study was to determine overall survival and the impact of treatment modality, stage, and HIV status on overall survival.

Methods: Women with vulvar cancer who presented to oncology care in Botswana from January 2015 through August 2019 were prospectively enrolled in this observational cohort study. Demographics, clinical characteristics, treatment, and survival data were collected. Factors associated with survival including age, HIV status, stage, and treatment were evaluated.

Results: Our cohort included 120 women with vulvar cancer. Median age was 42 (IQR 38-47) years. The majority of patients were living with HIV (89%, n=107) that was well-controlled on antiretroviral treatment. Among women with HIV, 54.2% (n=58) were early stage (FIGO stage I/II). In those without HIV, 46.2% (n=6) were early stage (stage I/II). Of the 95 (79%) patients who received treatment, 20.8% (n=25) received surgery, 67.5% (n=81) received radiation therapy, and 24.2% (n=29) received chemotherapy, either alone or in combination. Median follow-up time of all patients was 24.7 (IQR 14.2-39.1) months and 2- year overall survival for all patients was 74%. Multivariate analysis demonstrated improved survival for those who received surgery (HR 0.26; 95% CI 0.08 to 0.86) and poor survival was associated with advanced stage (HR 2.56; 95% CI 1.30 to 5.02). Survival was not associated with HIV status.

Conclusions: The majority of women with vulvar cancer in Botswana are young and living with HIV infection. Just under half of patients present with advanced stage, which was associated with worse survival. Improved survival was seen for those who received surgery.

Keywords: vulvar neoplasms.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curve of vulvar cancer patients in Botswana 2015–2019.
Figure 2
Figure 2
Kaplan–Meier survival curve of vulvar cancer patients in Botswana 2015–2019 by International Federation of Gynecology and Obstetrics (FIGO) stages I/II versus III/IV.
Figure 3
Figure 3
Kaplan–Meier survival curve of vulvar cancer patients in Botswana 2015–2019 by receipt of surgery.
See this image and copyright information in PMC

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