Temporal trends in vulvar cancer cases and associated factors of adverse clinical features: A 6-year retrospective study from a tertiary hospital in Indonesia
File(s)
Accepted version
Author(s)
Habiburrahman, Muhammad
Maesadatu Syaharutsa, Danny
Widya Utami, Tofan
Darma Putra, Andi
Kusuma, Fitriyadi
Type
Journal Article
Abstract
Purpose: Vulvar cancer (VC) is a rare malignancy with limited data in Southeast Asia. This 6-year retrospective cohort study aims to characterize temporal trends in VC cases in Indonesia, describe patients’ sociodemographic, obstetric, and clinicopathological features, and identify predictors of advanced stage and distant metastasis (DM).
Patients and methods: We analyzed 86 VC cases diagnosed between 2015 and 2020 at a tertiary
hospital in Indonesia. Patients’ sociodemographic and obstetric characteristics were described, and clinicopathological and treatment-related features were compared by stage and DM status. Temporal trends were assessed using Joinpoint regression, expressed as annual percentage change (APC). Subgroup analyses were conducted by age (<60 vs. ≥60 years), residential status (rural vs. urban), and DM presence (negative vs. positive). Univariate and multivariate logistic regression identified predictors of advanced-stage VC and DM, with model performance evaluated using the area under the receiver operating characteristic curve (AUC). Results: The number of VC cases increased significantly over six years (APC +21.43%, p=0.034), with the highest growth observed among older patients, rural residents, and cases without DM (+25.53% vs. +19.61%; +22.25% vs. +19.08%; +30.50% vs. +9.95%, respectively). Multivariate analysis identified urban residence (OR 5.12), right-sided lesion (OR 7.93), bilateral lesions (OR 10.25), and tumor volume ≥70 cm³ (OR 10.88) as independent predictors of advanced-stage VC (AUC 0.81, p<0.001). Predictors of DM included normal/underweight nutritional status (OR 5.50), presence of pain (OR 4.88), right-sided lesion (OR 13.80), and non-keratinized tumor subtype (OR 5.72) (AUC 0.80, p<0.001). Conclusion: The experience from an Indonesian referral hospital shows that the number of VC cases treated is rising, particularly among older adults, rural populations, and patients without DM. Specific clinicopathological features, including tumor laterality, bilaterality, volume, nutritional status, pain, and histological subtype, predict adverse outcomes, providing a foundation for improved risk stratification, early detection, and targeted management in underrepresented populations.
Patients and methods: We analyzed 86 VC cases diagnosed between 2015 and 2020 at a tertiary
hospital in Indonesia. Patients’ sociodemographic and obstetric characteristics were described, and clinicopathological and treatment-related features were compared by stage and DM status. Temporal trends were assessed using Joinpoint regression, expressed as annual percentage change (APC). Subgroup analyses were conducted by age (<60 vs. ≥60 years), residential status (rural vs. urban), and DM presence (negative vs. positive). Univariate and multivariate logistic regression identified predictors of advanced-stage VC and DM, with model performance evaluated using the area under the receiver operating characteristic curve (AUC). Results: The number of VC cases increased significantly over six years (APC +21.43%, p=0.034), with the highest growth observed among older patients, rural residents, and cases without DM (+25.53% vs. +19.61%; +22.25% vs. +19.08%; +30.50% vs. +9.95%, respectively). Multivariate analysis identified urban residence (OR 5.12), right-sided lesion (OR 7.93), bilateral lesions (OR 10.25), and tumor volume ≥70 cm³ (OR 10.88) as independent predictors of advanced-stage VC (AUC 0.81, p<0.001). Predictors of DM included normal/underweight nutritional status (OR 5.50), presence of pain (OR 4.88), right-sided lesion (OR 13.80), and non-keratinized tumor subtype (OR 5.72) (AUC 0.80, p<0.001). Conclusion: The experience from an Indonesian referral hospital shows that the number of VC cases treated is rising, particularly among older adults, rural populations, and patients without DM. Specific clinicopathological features, including tumor laterality, bilaterality, volume, nutritional status, pain, and histological subtype, predict adverse outcomes, providing a foundation for improved risk stratification, early detection, and targeted management in underrepresented populations.
Date Acceptance
2026-04-02
Citation
International Journal of Women's Health
ISSN
1179-1411
Publisher
Dove Medical Press
Journal / Book Title
International Journal of Women's Health
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted