Demographics, pathologic characteristics, and pattern of recurrence of vulvar cancer at an academic hospital in South Africa: A 10-year retrospective review.

e17602 Background: Vulvar cancer although uncommon, accounts for about 5% of all gynecologic malignancies. Globally, it accounted for over 45 000 new cases and 17 000 deaths in the Globocan 2020 cancer estimates with an age-standardized rate (ASR) for incidence and mortality of 0.9 and 0.3 respectively. Vulvar cancer shares common risk factors with cervical cancer and over 90% of these are squamous cell carcinoma. In Africa, there is paucity of data on the true prevalence and recurrent rate of vulvar cancer albeit due to its rarity or poor record keeping. The current study aimed to describe the demographics, pathological characteristics and recurrence pattern of vulvar cancer at a single academic institution in South Africa. Methods: This was a retrospective descriptive observational study of vulvar cancer cases at the Gynaecologic Oncology Unit of Steve Biko Academic Hospital, Pretoria between 1 st January 2012 and 31 st December 2021. Data was extracted from the participants medical records on the demographics, medical history, site of tumour, disease stage, histologic characteristic and disease recurrence. The 2009 FIGO staging was used to classify the disease stage. Results: A total of 317 patients were included for analysis. The mean age was 45±12 yrs (range: 12-87). Majority were below 50yrs (71.9%) while 28.1% were 50yrs and above, 77.9% were HIV positive (median CD4 count was 428 cells/mm 3 , IQR= 277-662), 19.2% were HIV negative while the HIV status of 2.9% were unknown. The mean hemoglobin level at presentation was 10.7 ± 2.4g/dl. The average interval between biopsy at local clinic and presentation at the gynaecologic oncology clinic was 80days. The average number of patients seen was 31.7 per year. The majority, 79.1%, had tumours >4cm. Only about 45% of the patients had multifocal lesions. The left vulvar was significantly more affected than the right, 57.3%, (p 0.001). The anus was the most frequent contiguous structure involved in vulvar cancer, 47.5%. Squamous cell carcinoma was diagnosed in 96.5% of the participants and the most common histological grade was grade 2, at 69.9%. A large proportion of the participants,63%, presented in advanced stage (Stage 3 & 4). The mean follow up period was 23.1±26 months. The recurrence rate was 16.4%, of which 49% were local recurrence, 10.2% occurred in the groin, 22.5% involved the local and groin sites together, and 18.3% occurred at distant sites. Conclusions: Our data showed that the demographic characteristics of local patients with vulvar cancer are different from those in the developed world. The high recurrence rate might be due to the advanced disease at presentation of the majority of the patients.