The following is a summary of “Guideline-Discordant Care in Early-Stage Vulvar Cancer” published in the December 2022 issue of Obstetrics & Gynecology by Bercow et al.

For a study, researchers sought to explain the application of inguinofemoral lymph node (LN) assessment in people with early-stage vulvar cancer that complies with National Comprehensive Cancer Network guidelines.

The retrospective cohort analysis used the National Cancer Database to identify individuals diagnosed with T1b and T2 vulvar squamous cell carcinomas between 2012 and 2018. Using logistic regression models to account for the patient, illness, and facility-level traits. The complete cohort and an older patient subset, defined as patients 80 years of age or older, were subjected to a Kaplan-Meier survival analysis using log-rank test and Cox regression.

Over 3,756 (66.1%) of the 5,685 vulvar cancer patients had LN assessment in accordance with guidelines. Age 80 or older (odds ratio [OR], 0.30; 95% CI 0.22–0.42) and Black race (odds ratio [OR], 0.72; 95% CI 0.54-0.95) were related with decreased probabilities of LN assessment in the adjusted model. Compared to low-volume hospitals, high-volume hospitals were linked with higher chances of LN assessment (OR 1.62; 95% CI 1.28-2.05). Older people who did not have their LNs evaluated had substantially shorter overall survival than those with pathologically negative LNs (hazard ratio [HR] 0.45; 95% CI 0.37-0.55) and comparable overall survival to those with pathologically positive LN (HR 1.05; 95% CI 0.77-1.43).

Low rates of LN assessment for early-stage vulvar squamous cell carcinoma were consistent with guidelines. Older age, Black race, and hospital treatment with low patient volumes are all related to lower usage.