Sylvester Researchers Show Tumor Size Can Predict Vaginal Cancer Survival

Researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine have shown that tumor size in women with stage I or II vaginal cancer can strongly influence their overall survival.

Using the Surveillance, Epidemiology and End Results (SEER) database, the team found that the five-year overall survival rate for patients with stage I tumors that were 2 centimeters or smaller at time of diagnosis was 79.2 percent. However, in those with larger tumors, survival dropped to 66.1 percent.

The results were even more pronounced in stage II cancers: 80.9 percent survival for patients with tumors at most 2 centimeters, compared with 51.2 percent for those with larger lesions. These findings could ultimately change how vaginal cancers are staged and lead to more precise treatment. The research was published in the journal Gynecologic Oncology.

“This preliminary analysis is a breakthrough that could change practice once it’s validated,” said first author Aaron Wolfson, M.D., co-leader of the Gynecologic Cancers Site Disease Group at Sylvester and professor of radiation oncology, and obstetrics and gynecology at the University of Miami Miller School of Medicine. “The net effect may be a major change in prognosis just by measuring the tumor in the physician’s office.”

Sponsored by the National Cancer Institute, the SEER database provides statistics for a wide range of cancers, focusing on cancer incidence and survival. From the database, the team identified 529 patients with stage I or II vaginal cancer who had been diagnosed between 2004 and 2012 and their tumor sizes recorded.

Though vaginal cancer is rare, it can be deadly, killing 910 women in 2015. By linking tumor size with prognosis, this study provides a pathway to improve care and save lives.

“Even though it is a relatively rare disease, women are still dying from vaginal cancer,” said Brian Slomovitz, M.D., who directs the Division of Gynecologic Oncology at Sylvester. “We desperately need to identify those patients who would benefit from more aggressive treatment, while sparing the side effects of therapy for those with low-risk disease.”

In addition to this publication, the results from this study are being evaluated by the American Joint Committee on Cancer (AJCC), which controls how cancers are staged in the United States. These findings are also being reviewed by the International Federation of Gynecologists and Obstetricians, which sets worldwide cancer staging guidelines.

If adopted by these organizations, the findings could go far toward personalizing care for women with vaginal cancer. Currently, vaginal cancer is often treated with surgery and/or different types of radiation therapy. However, new guidelines might change how early stage patients are treated.

“It’s possible that a small stage I tumor might be treated with surgery alone,” noted Wolfson.

This is the first step in a conversation about how best to treat vaginal cancer. Wolfson and colleagues believe this could ultimately lead to clinical trials to investigate more-aggressive treatments for larger tumors, such as chemotherapy for patients with large stage II lesions. Other research could build on this study, redefining the relationship between tumor size and cancer prognosis.

“If the AJCC accepts these results, the SEER registry will start querying tumor size,” said Wolfson. “Researchers will hopefully use that to validate what we found in our preliminary analysis.”

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