Factors that affect survival in vaginal cancer: a seer analysis

This study aimed to investigate the factors that affect survival in vaginal cancer by means of a large population-based database that had been monitored over a 42 year period (1975–2017). It was investigated which factors were most predictive in survival. This study evaluated the factors that affect survival in primary vaginal cancer as one of the rarest gynaecological cancers. Relationships were explored between survival and age and race of patient, in situ/invasive behaviour of tumour, histological type, stage, grade, surgical treatment, and year of diagnosis. Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more predictive of mortality in older patients and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery. At the end of this study, an estimation model was developed for 10-year survival in vaginal cancer and software was created for the model. Impact StatementWhat is already known on this subject? Primary vaginal cancer is very rare, accounting for 2% of female genital tract malignancies. Due to its low incidence and difficulty of its final diagnosis, vaginal cancer has the least amount of data among all female genital tract malignancies. It is difficult for clinicians to estimate the survival with already limited data on vaginal cancer in the literature.What do the results of this study add? Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more effective in mortality with older age and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery.What are the implications of these findings for clinical practice and/or further research? It is anticipated that such studies will contribute to the transformation of societal data collection methods into a prospective nature and lead the way for stronger survival estimation models to be developed in days to come. What is already known on this subject? Primary vaginal cancer is very rare, accounting for 2% of female genital tract malignancies. Due to its low incidence and difficulty of its final diagnosis, vaginal cancer has the least amount of data among all female genital tract malignancies. It is difficult for clinicians to estimate the survival with already limited data on vaginal cancer in the literature. What do the results of this study add? Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more effective in mortality with older age and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery. What are the implications of these findings for clinical practice and/or further research? It is anticipated that such studies will contribute to the transformation of societal data collection methods into a prospective nature and lead the way for stronger survival estimation models to be developed in days to come.

本研究旨在借助一项覆盖42年（1975-2017年）的长期监测大型基于人群的数据库（population-based database），探究影响阴道癌生存预后的相关因素，并明确对生存预后最具预测价值的因子。作为一类极为罕见的妇科恶性肿瘤（gynaecological cancers），本研究同时评估了原发性阴道癌（primary vaginal cancer）生存预后的影响因素。研究分析了患者年龄、种族、肿瘤原位/浸润性状态（in situ/invasive tumour behaviour）、组织学类型、临床分期、肿瘤分级、外科治疗方式以及诊断年份与生存结局之间的关联。

研究结果显示：年轻患者、早期病变患者、原位癌及鳞状细胞癌（squamous cell carcinoma）患者、接受过既往手术的患者，以及2000年及之后确诊的患者，其生存率更高。老年患者的死亡原因更多为非肿瘤相关因素，而2000年及之后确诊的患者中，非肿瘤相关死亡率有所下降。接受手术治疗的患者肿瘤相关死亡率更低。本研究最终构建了阴道癌10年生存预后预测模型，并开发了配套的模型软件。

#### 影响声明（Impact Statement）
##### 该领域已有研究共识
原发性阴道癌极为罕见，仅占女性生殖道恶性肿瘤的2%。由于其发病率较低且最终诊断难度大，阴道癌是所有女性生殖道恶性肿瘤中临床数据最少的癌种。现有文献中关于阴道癌的有限数据，使得临床医师难以准确评估患者的生存预后。
##### 本研究的新增发现
本研究证实，年轻患者、早期病变患者、原位癌及鳞状细胞癌患者、接受过既往手术的患者，以及2000年及之后确诊的患者生存率更高；同时发现，老年患者的死亡更多由非肿瘤相关因素导致，且2000年及之后确诊的患者中非肿瘤相关死亡率有所降低；接受手术治疗的患者肿瘤相关死亡率显著更低。
##### 研究结果对临床实践及后续研究的启示
本研究有望推动社会人群数据收集模式向前瞻性方向转型，并为未来开发更精准的生存预后预测模型提供参考依据。

该领域已有研究共识
原发性阴道癌极为罕见，仅占女性生殖道恶性肿瘤的2%。由于其发病率较低且最终诊断难度大，阴道癌是所有女性生殖道恶性肿瘤中临床数据最少的癌种。现有文献中关于阴道癌的有限数据，使得临床医师难以准确评估患者的生存预后。

本研究的新增发现
本研究证实，年轻患者、早期病变患者、原位癌及鳞状细胞癌患者、接受过既往手术的患者，以及2000年及之后确诊的患者生存率更高；同时发现，老年患者的死亡更多由非肿瘤相关因素导致，且2000年及之后确诊的患者中非肿瘤相关死亡率有所降低；接受手术治疗的患者肿瘤相关死亡率显著更低。

研究结果对临床实践及后续研究的启示
本研究有望推动社会人群数据收集模式向前瞻性方向转型，并为未来开发更精准的生存预后预测模型提供参考依据。