Association of hospital-level factors with utilization of sentinel lymph node biopsy in patients with early-stage vulvar cancer

Alexandra S. Bercow, J. Alejandro Rauh-Hain, Alexander Melamed, Varvara Mazina, Whitfield B. Growdon, Marcela G. del Carmen, Annekathryn Goodman, Sara Bouberhan, Thomas Randall, Rachel Sisodia, Amy Bregar, Eric L. Eisenhauer, Christina Minami, George Molina

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate utilization of sentinel lymph node biopsy (SLNB) for early-stage vulvar cancer at minority-serving hospitals and low-volume facilities. Methods: Between 2012-2018, individuals with T1b vulvar squamous cell carcinoma were identified using the National Cancer Database. Patient, facility, and disease characteristics were compared between patients undergoing SLNB or inguinofemoral lymph node dissection (IFLD). Multivariable logistic regression, adjusted for patient, facility, and disease characteristics, was used to evaluate factors associated with SLNB. Kaplan-Meier survival analysis using log rank test and Cox regression was performed. Results: Of the 3,532 patients, 2,406 (68.1%) underwent lymph node evaluation, with 1,704 (48.2%) undergoing IFLD and 702 (19.8%) SLNB. In a multivariable analysis, treatment at minority-serving hospitals (OR 0.39, 95% CI 0.19–0.78) and low-volume hospitals (OR 0.44, 95% CI 0.28–0.70) were associated with significantly lower odds of undergoing SLNB compared to receiving care at non-minority-serving and high-volume hospitals, respectively. While SLNB utilization increased over time for the entire cohort and stratified subgroups, use of the procedure did not increase at minority-serving hospitals. After controlling for patient and tumor characteristics, SLNB was not associated with worse OS compared to IFLD in patients with positive (HR 1.02, 95% CI 0.63–1.66) or negative (HR 0.92, 95% CI 0.70–1.21) nodal pathology. Conclusions: For patients with early-stage vulvar cancer, treatment at minority-serving or low-volume hospitals was associated with significantly decreased odds of undergoing SLNB. Future efforts should be concentrated toward ensuring that all patients have access to advanced surgical techniques regardless of where they receive their care.

Original languageEnglish (US)
Pages (from-to)47-54
Number of pages8
JournalGynecologic oncology
Volume169
DOIs
StatePublished - Feb 2023

Keywords

  • Hospital volume
  • Minority-serving hospital
  • National Cancer Database
  • Sentinel lymph node biopsy
  • Vulva
  • Vulvar cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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