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Predicting causes of death among vulvar cancer patients; SEER database analysis

Background: This study aims to identify causes of death among vulvar cancer patients diagnosed in the period between 2004 and 2013, using the Surveillance, Epidemiology, and End-Results (SEER) Program. Patients Methods: Data of 3769 Women with vulvar cancer, aged 40 years or more were extracted. Causes of death were categorized into vulvar cancer death, other cancer death, and other causes of death. The statistical analysis was performed using R (Version 3.4.0) utilizing the survival package (Version 2.41-3) and competing for the risk package. Results: At the end of the follow-up period, 2520 patients (66.9%) were alive while 1249 patients (33.14%) were dead. Of the 1249 deaths, 632 (50.6%) were attributed to vulvar cancer, 184 (14.7%) to other cancers, and 433 (34.66%) to other causes of death. Cardiovascular diseases and other gynecological cancers were the most common causes of death after vulvar cancer representing 16.65% and 5.28% of all deaths respectively. Advanced disease stage and more than three positive lymph nodes were associated with an increased risk of death due to other cancers. Simple and total surgeries were associated with lower risk. Non-cancer-related deaths were higher in unmarried women or in those who underwent surgical treatment. Conclusions: Non-cancer causes in addition to cancers other than vulvar cancer account for half of all deaths that occurred among patients diagnosed with vulvar cancer. Cardiovascular diseases and other gynecologic cancers are the most significant causes of death after vulvar cancer.