Background
Vulvar cancer is a rare gynecologic malignancy; survival data from low-resource settings remain limited. Vulvar cancer, although rare, makes up about 5% of gynecological cancers. Although vulvar cancer is predominantly seen in older women, it is increasingly occurring in younger women. The rarity of vulvar cancer poses clinical challenges, often leading to delayed diagnoses. Due to the low incidence of vulvar cancer, there is limited comprehensive data on long-term survival and prognostic factors. Furthermore, delayed diagnosis significantly worsens the prognosis

Objectives
We evaluated survival rates and associated factors in vulvar cancer at the National Cancer Referral Center in Tanzania.

Methods

We conducted a retrospective cohort study of women with histologically confirmed vulvar cancer treated at Ocean Road Cancer Institute (ORCI) between January 2019 and December 2021. Demographic, clinical, pathologic, and treatment-related data were abstracted from medical records. Overall survival (OS) was estimated using the Kaplan–Meier method. Associations between clinicopathologic factors and mortality were assessed using Cox proportional hazards regression.

Results
Among 127 eligible patients, the mean age at diagnosis was 49 years, and 62.2% were HIV positive. Squamous cell carcinoma accounted for 89% of tumors. The 1-, 2-, and 3-year Overall survival (OS) rates were 72.7%, 61.6%, and 52.5%, respectively. On univariable analysis, advanced FIGO stage, lymph node involvement, and absence of surgical treatment were associated with worse survival. In multivariable analysis, advanced stage remained the only independent predictor of mortality (adjusted hazard ratio, p = 0.012)

Conclusions/Implications for practice or policy
In this national referral cohort, vulvar cancer survival was modest, with advanced-stage disease strongly associated with mortality. These findings underscore the importance of early diagnosis and timely, stage-appropriate treatment to enhance outcomes in low-resource settings.