Prognostic impact of clinical tumor size on overall survival for subclassifying stages I and II vaginal cancer: A SEER analysis

Purpose This study accessed the Surveillance, Epidemiology and End Results (SEER) database to determine if tumor size is an independent predictor of overall survival (OS) for patients with stages I and II vaginal cancer (VC). Materials and methods We identified in the SEER database, patients with available tumor size having stage I or II squamous cell histology from January 2004 through December 2012 with minimum follow-up of six months. Univariate analyses (UA) and multivariable analyses (MVA) evaluated the effect of several prognostic factors, including tumor size, regarding OS. Results 529 SEER patients were found with recorded tumor sizes, of which 293 (55.4%) were stage I and 236 (44.6%) stage II. UA found the following significant prognostic factors of worse OS: tumor size > 2 cm (HR = 1.80, p = 0.02) and older age at diagnosis (p < 0.001) in stage I; and tumor size > 2 cm (HR = 2.13, p = 0.04) and older age at diagnosis (p < 0.001) in stage II. Estimates of 5-year OS in patients with tumor size ≤ 2 cm vs. > 2 cm were 79.2% vs. 66.1% in stage I (p = 0.0187) and 80.9% vs. 51.2% in stage II (p = 0.0369). MVA confirmed about double risk of death for patients with tumor size > 2 cm (HRs: 1.88 in stage I and 2.06 in stage II). Conclusions Tumor size seems to predict OS outcome in patients with stages I/II VC. Further confirmatory investigations are recommended to firmly establish its incorporation into currently accepted staging criteria for these patients.