Clinical characteristics, treatment patterns, and prognosis in vulvar cancer and vaginal cancer: A national multicenter retrospective study in China

Background Vulvar and vaginal cancers significantly impact women's health and quality of life. This study analyzes the prevalence of human papillomavirus (HPV), clinicopathological characteristics, treatment patterns, and survival outcomes, to understand their relationships and better guide prevention and therapy Chinese patients with vulvar or vaginal cancer. Methods We conducted a retrospective study across nine tertiary hospitals in seven Chinese regions, including patients diagnosed and treated between 2017 and 2022. Data were collected from medical records and questionnaires, with routine follow-up. Survival was analyzed using Kaplan-Meier and log-rank tests; other comparisons used Wilcoxon rank-sum, Chi-square, and Fisher’s exact tests. Results A total of 218 patients (131 vulvar, 87 vaginal) were analyzed. HPV infection was significantly higher in vaginal than vulvar cancer (76.1% vs. 33.8%, p < 0.001). Among vulvar cancer patients, HPV-positive cases were diagnosed at a younger age (p = 0.027). Both vulvar and vaginal cancers were predominantly early-stage (FIGO I: 57.3% vs. 51.7%), but vulvar tumors were more often well-differentiated (46.7%), while vaginal cancers were mainly moderately (39.2%) or poorly differentiated (23.5%). Surgery was more common in vulvar cancer (84.6% vs. 50.6%, p < 0.001), often without adjuvant therapy (p = 0.016). Primary surgery was associated with improved overall survival in vulvar cancer (p < 0.001), but not in vaginal cancer. A non-significant trend toward longer disease-free survival was observed in HPV-positive vulvar cancer patients (p = 0.116). Conclusions Vulvar and vaginal cancers exhibit distinct profiles in histological differentiation, HPV prevalence and age association. Surgery is central to vulvar cancer management and correlates with survival benefit, whereas vaginal cancer treatment is more heterogeneous. HPV status may have modest prognostic relevance in vulvar cancer, warranting further study.