The impact of frailty on treatment strategies and survival outcomes of vulvar cancer patients: a systematic review

Background: Vulvar cancer is an uncommon gynecologic malignancy that is usually manifested in older ages which have several comorbidities. Frail patients pose a significant subgroup in gynecologic oncology as frailty may affect treatment plans and result in significant reduction of survival outcomes. In the present systematic review we summarize current evidence focusing on the impact of frailty in vulvar cancer patients. Methods: We systematically searched the international literature using the Medline, Scopus, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar until March 2025. Prospective and retrospective studies were considered eligible for inclusion. Results: Six articles were included in the present systematic review that involved 2,785 patients. Significant heterogeneity was noted as well as methodological issues that were mainly based on the absence of control group in the majority of included studies. The meta-analysis indicated that non-frail patients had increased chances of survival (HR 2.40, 95% CI 1.27, 4.54) whereas the rate of complications was particularly different among studies included, ranging between 6 and 79% of cases (OR 0.26, 95% CI 0.10, 0.51). The actual impact of frailty on treatment decisions was particularly underreported, whereas none of the studies included correlated treatment decisions with survival outcomes. Conclusion: Current evidence focusing on the impact of frailty on survival outcomes and treatment plans in vulvar cancer patients is extremely scarce. Considering that this group of patients involves older patients, more research is needed to evaluate the optimal management of these cases.