Clinical characteristics, treatment patterns, and prognosis in vulvar cancer and vaginal cancer: a national multicenter retrospective study in China

BACKGROUND: Vulvar and vaginal cancers significantly impact women’s health and quality of life. This study analyzes the prevalence of human papillomavirus (HPV), clinicopathological characteristics, treatment patterns, and survival outcomes, to understand their relationships and better guide prevention and therapy for Chinese patients with vulvar or vaginal cancer. METHODS: We conducted a retrospective, multicenter study across nine tertiary hospitals located in seven regions of China, including patients diagnosed and treated between 2017 and 2021. Data were collected from medical records and standardized questionnaires, with routine clinical follow-up. Continuous variables were analyzed using the Wilcoxon rank-sum test, while categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Survival outcomes, including overall survival and disease-free survival, were evaluated using the Kaplan-Meier method and multivariable cox proportional hazards regression. RESULTS: A total of 218 patients (131 vulvar, 87 vaginal) were analyzed. HPV infection was significantly higher in vaginal than vulvar cancer (76.1% vs. 33.8%, p < 0.001). A non-significant trend toward younger age at diagnosis has been observed in HPV-positive vulvar cancer patients (p = 0.072). Both vulvar and vaginal cancers were predominantly early-stage (FIGO I: 57.3% vs. 51.7%), but vulvar tumors were more often well-differentiated (46.7%), while vaginal cancers were mainly moderately (39.2%) or poorly differentiated (23.5%). Receiving surgery during primary treatment phase was more common in vulvar cancer (84.6% vs. 50.6%, p < 0.001), often without adjuvant therapy (p = 0.016). Primary surgery was associated with longer overall survival and disease-free survival in vulvar cancer (p < 0.001), but not in vaginal cancer. A non-significant trend toward longer disease-free survival was observed in HPV-positive vulvar cancer patients (p = 0.107). CONCLUSIONS: Vulvar and vaginal cancers exhibit distinct profiles in histological differentiation, HPV prevalence and age association. Surgery is central to vulvar cancer management and correlates with survival benefit, whereas vaginal cancer treatment is more heterogeneous. HPV status may have modest prognostic relevance in vulvar cancer, warranting further study.