Abstract
Vulvar cancer is an extremely rare complication during pregnancy, and its effect on
pregnancy and survival is not well understood. A systematic literature review was
conducted in order to examine the fetal and maternal outcomes and optimal management
of pregnancy complicated by vulvar cancer. PubMed/MEDLINE were used to identify case
reports with searching keywords “pregnancy” and “vulvar cancer” between January 1955
and February 2014 that identified 36 cases for analysis. Mean age was 30.7. The most
common presenting symptom and gestational age were vulvar mass/swelling (75.0%) and
the second trimester of pregnancy (54.8%), respectively. Vulvar biopsy at the time
of initial presentation to care during pregnancy was performed in only 46.7% of cases.
Among delayed cases for biopsy, mean duration of delay was 12.8 weeks and the majority
had a delay for more than 8 weeks (62.5%). The majority of vulvar cancer was squamous
histology (47.2%) and stage I disease (60.0%). Vulvectomy and inguinal–femoral lymphadenectomy
were performed in 97.1% and 63.9%, respectively. Abdominal delivery was recorded in
46.2% of cases. Live birth and full term delivery rates were 96.3% and 74.0%, respectively.
For survival analysis, delay in diagnosis and advanced stage disease were commonly
associated with decreased disease-free survival (5-year rate, delay in diagnosis >8
versus ≤8 weeks, 0% versus 69.1%, hazard ratio (HR) 7.86, 95% confidence interval (CI) 2.03–30.6, p = 0.001; and stage III–IV versus stage I–II, 0% versus 59.8%, HR 3.35, 95% CI 1.16–9.68, p = 0.011) and overall survival (5-year rate, delay in diagnosis >8 versus ≤8 weeks, 0% versus 67.1%, hazard ratio (HR) 14.8, 95% CI 1.77–124, p = 0.001; and stage III–IV versus stage I–II, 0% versus 86.4%, HR 8.22, 95% CI 2.06–33.2, p < 0.001). In conclusion, while the majority of cases resulted in good pregnancy outcomes,
diagnosis of vulvar cancer during pregnancy is frequently delayed. Since delayed diagnosis
is a significant prognosticator of decreased survival outcomes, early recognition
is integral in the management of pregnancy complicated by vulvar cancer.
Keywords
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Article info
Publication history
Published online: April 21, 2014
Accepted:
April 8,
2014
Received in revised form:
March 26,
2014
Received:
December 30,
2013
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
