International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2026
Patterns of excess and cause-specific mortality in vulvar squamous cell carcinoma: a Surveillance, Epidemiology, and End Results program population-based study.
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Tran Hue T T, Doan Nhi H, Le Duc V, Shrestha Raslina, Warring Simrit K, Thomé Stephan D, Wetter David A, Bakkum-Gamez Jamie N, Nguyen Giang H
Аннотация
OBJECTIVE: To characterize population-level excess mortality relative to the general U.S. population and cause-specific mortality patterns within a competing-risks framework among patients with vulvar squamous cell carcinoma.
METHODS: We conducted a population-based study using the Surveillance, Epidemiology, and End Results program (2000-2022). Standardized mortality ratios and excess absolute risks were used to assess excess mortality. Cause-specific mortality was analyzed using cumulative incidence functions and Fine-Gray competing-risk models.
RESULTS: Among 13,924 patients, 52.2% died during follow-up over 83,357 person-years at risk. Vulvar squamous cell carcinoma was the leading cause of death (21.9%), followed by cardiovascular disease (8.9%) and other malignancies (8.7%). Compared with the general population, patients had excess mortality not only from vulvar squamous cell carcinoma but also from second malignancies and non-cancer conditions, including cardiovascular disease, chronic obstructive pulmonary disease, infection, and diabetes. In competing-risk analyses, advanced stage was strongly associated with higher vulvar squamous cell carcinoma-specific mortality. Higher cardiovascular disease mortality was observed among Black patients, and higher cardiovascular disease and chronic obstructive pulmonary disease mortality among unmarried patients.
CONCLUSIONS: Patients with vulvar squamous cell carcinoma experience substantial excess mortality beyond cancer. These findings highlight the importance of survivorship care addressing second malignancies, cardiopulmonary comorbidities, and social disparities.
METHODS: We conducted a population-based study using the Surveillance, Epidemiology, and End Results program (2000-2022). Standardized mortality ratios and excess absolute risks were used to assess excess mortality. Cause-specific mortality was analyzed using cumulative incidence functions and Fine-Gray competing-risk models.
RESULTS: Among 13,924 patients, 52.2% died during follow-up over 83,357 person-years at risk. Vulvar squamous cell carcinoma was the leading cause of death (21.9%), followed by cardiovascular disease (8.9%) and other malignancies (8.7%). Compared with the general population, patients had excess mortality not only from vulvar squamous cell carcinoma but also from second malignancies and non-cancer conditions, including cardiovascular disease, chronic obstructive pulmonary disease, infection, and diabetes. In competing-risk analyses, advanced stage was strongly associated with higher vulvar squamous cell carcinoma-specific mortality. Higher cardiovascular disease mortality was observed among Black patients, and higher cardiovascular disease and chronic obstructive pulmonary disease mortality among unmarried patients.
CONCLUSIONS: Patients with vulvar squamous cell carcinoma experience substantial excess mortality beyond cancer. These findings highlight the importance of survivorship care addressing second malignancies, cardiopulmonary comorbidities, and social disparities.