Risk factors for vulvar dysplasia recurrence in patients from southwestern Virginia and surrounding states: A retrospective cohort study

Abstract

Objective. To determine whether distance to a tertiary care center is an independent risk factor for recurrence of VIN 2/3 or invasive vulvar cancer.

Methods. A retrospective chart review included individuals with VIN 2/3 from southwest Virginia and surrounding states treated at a single institution. The patients were treated from 1/1/2010 to 12/31/2020. Medical records were reviewed for demographics, risks factors, distance to care determined by a geographic information system (GIS) software, treatment modality, and recurrent disease.

Results. We identified 251 patients. Most patients were Caucasian (92%) and had history of tobacco use (current [49%] and former [27.5%] tobacco users). Patients traveled an average of 20 miles for care (range: 0.3-113.9 miles). Most commonly, VIN 2/3 was treated with excision (n=136), excision and ablation (n=59), or ablation alone (n=31). The average lesion size was 20 mm (range: 2, 100 mm). Thirty-five percent of patients (n=88) developed recurrent VIN 2/3, on average, 9.6 months (range: 0.1, 7.8 years) following treatment. Recurrences were associated with increased body mass index (p=0.049), immunocompromised status (p=0.039), steroid use (p=0.024), and positive margins (p=0.0003). No subsequent diagnoses of cancer were made. Logistic regression showed that margin status was the only field impacting recurrence (p=0.0075; OR=2.63, 95% CI: 1.30-5.35). Distance to care was not related to recurrence risk (p>0.05).

Conclusions. Our findings confirm known risk factors for current disease, while indicating that distance to care does not impact their recurrence. Further research is merited to investigate other recurrence risk factors that were not included in our model.