Purpose: Vulvar cancer (VC) is a rare malignancy with limited data in Southeast Asia. This 6-year retrospective cohort study aims to characterize temporal trends in VC cases in Indonesia, describe patients’ sociodemographic, obstetric, and clinicopathological features, and identify predictors of advanced stage and distant metastasis (DM). Patients and Methods: We analyzed 86 VC cases diagnosed between 2015 and 2020 at a tertiary hospital in Indonesia. Patients’ sociodemographic and obstetric characteristics were described, and clinicopathological and treatment-related features were compared by stage and DM status. Temporal trends were assessed using Joinpoint regression, expressed as annual percentage change (APC). Subgroup analyses were conducted by age (< 60 vs ≥ 60 years), residential status (rural vs urban), and DM presence (negative vs positive). Univariate and multivariate logistic regression identified predictors of advanced-stage VC and DM, with model performance evaluated using the area under the receiver operating characteristic curve (AUC). Results: The number of VC cases increased significantly over six years (APC +21.43%, p=0.034), with the highest growth observed among older patients, rural residents, and cases without DM (+25.53% vs +19.61%; +22.25% vs +19.08%; +30.50% vs +9.95%, respectively). Multivariate analysis identified urban residence (OR 5.12), right-sided lesion (OR 7.93), bilateral lesions (OR 10.25), and tumor volume ≥ 70 cm³ (OR 10.88) as independent predictors of advanced-stage VC (AUC 0.81, p< 0.001). Predictors of DM included normal/underweight nutritional status (OR 5.50), presence of pain (OR 4.88), right-sided lesion (OR 13.80), and non-keratinized tumor subtype (OR 5.72) (AUC 0.80, p< 0.001). Conclusion: The experience from an Indonesian referral hospital shows that the number of VC cases treated is rising, particularly among older adults, rural populations, and patients without DM. Specific clinicopathological features, including tumor laterality, bilaterality, volume, nutritional status, pain, and histological subtype, predict adverse outcomes, providing a foundation for improved risk stratification, early detection, and targeted management in underrepresented populations. Plain Language Summary: Vulvar cancer is a rare, and information from Southeast Asia is limited. Doctors in the region often rely on data from Western countries, which may not reflect local healthcare access and referral patterns. This study analyzed 86 cases diagnosed between 2015 and 2020 at a major hospital in Indonesia to explore trends and factors linked to disease severity. We found that the number of cases rose by about 21% per year, especially among older and rural patients. Most women were diagnosed at an advanced stage, suggesting delayed recognition or referral. Women living in cities, those with right- or both-sided tumors, and those with larger tumors were more likely to have advanced-stage disease. Cancer spread to distant organs was more common in women who reported pain, had right-sided tumors, non-keratinized tumor types, or poorer nutritional status. These results do not represent national disease rates but instead show patterns of presentation in an Indonesian referral center. Recognizing warning signs, such as persistent vulvar symptoms, pain, or large or bilateral lesions, may help doctors refer patients earlier and diagnose sooner. Improving awareness and referral pathways could allow treatment to begin earlier and may improve patient outcomes. This graphical abstract figure is divided into two main panels: a left panel providing background and study aims, and a right panel presenting analytical results. The left panel is titled “Vulvar cancer (VC)” and includes an illustration alongside a map highlighting Indonesia within the Southeast Asian region. Accompanying text describes VC as a rare malignancy with limited epidemiological data. Below this, a section titled “We aim for:” outlines the study objective: to characterise trends and determinants of advanced disease features in VC in Indonesia. The dataset consists of 86 VC cases collected between 2015 and 2020 at Dr Cipto Mangunkusumo Hospital. The right panel presents results in two sections. The upper section, titled “Trend analyses”, reports annual percentage change (APC) in incidence. Findings include an overall increase of +21.4% (p = 0.034), with higher increases observed among older patients (+25.5%), rural residents (+22.3%), and non-metastatic cases (+30.5%). The bottom right section, titled “Risk factors”, summarises predictors for two outcomes. For advanced-stage VC, identified risk factors include urban residence (OR 5.12), bilateral lesions (OR 10.25), right-sided lesions (OR 7.93), and tumour volume ≥ 70 cm³ (OR 10.88), with model performance of AUC 0.81 (95% CI 0.70– 0.92; p < 0.001). For distant metastasis, risk factors include normal or underweight body mass index (OR 5.50), right-sided lesions (OR 13.80), presence of pain (OR 4.88), and non-keratinised tumours (OR 5.72), with model performance of AUC 0.80 (95% CI 0.70– 0.90; p < 0.001).An infographic presents trend analyses and risk factors for vulvar cancer (VC). Keywords: vulvar cancer, Indonesia, trend analysis, rural-urban disparities, advanced-stage predictors, distant metastasis predictors
Habiburrahman et al. (Wed,) studied this question.