Squamous Cell Carcinoma of the Vulva: Clinicopathological Correlations and Prognostic Significance of HPV Infection and FIGO Staging
V Fuste, I Alonso, P Castillo, M del Pino, A Torne, J Ordi. Hospital Clinic, IDIBAPS, Barcelona, Spain
Background: Invasive vulvar squamous cell carcinoma (VSCC) accounts for more than 90% of malignant vulvar neoplasms, but it represents only 3-5% of all cancers of the female genital tract. Based on their etiopathogenesis VSCCs have been divided into two groups with different clinical and pathological features. One group expresses sequences of high-risk human papillomavirus (HPV), whereas the other arises via independent-HPV pathways. The prognostic significance of these pathological groups is still controversial. In this study we evaluate the prognostic implications of HPV infection and surgical staging in a series of VSCCs, treated at a single institution.
Design: All VSCCs diagnosed at the Hospital Clinic of Barcelona from 1990 to 2007 were retrospectively evaluated (n=94). Clinical and pathological data were reviewed. HPV infection was determined and typed by amplification of HPV DNA by PCR using the SPF-10 primers. p16INK4a and p53 expression were determined by immunohistochemistry. Patients were followed-up 1-237 months (median 25 months). Overall and progression-free survival for HPV-positive and –negative patients and for stages I to IV were estimated by Kaplan-Meier analysis and by the use of a multivariate Cox proportional hazard's model.
Results: HPV DNA was detected in tumor tissue of 18/94 (19%) patients. HPV16 was the most prevalent viral type. HPV-negative women were significantly older than HPV-positive patients (77.4±11.2 vs. 65.0±22.3, p<.001) Immunohistochemistry for p16INK4a stained all HPV-positive and one of 76 HPV-negative tumors (100% vs. 1.3%, p<.001). p53 was positive in 1/18 HPV-positive tumors and 54/76 HPV-negative (5.5% vs. 71.0%, p<.001). No differences in FIGO staging between HPV-positive and –negative patients were observed (stage I: 22.2% vs. 31.6%; stage II: 27.6% vs. 33.3%; stage III: 34.2% vs. 22.2%; and stage IV: 6.6% vs. 22.2%; p=.320). Both progression-free and overall survival were associated with FIGO staging (p<.001, log-rank test). In contrast, no differences either in progression-free and overall survival were observed when comparing HPV-positive and –negative cases.
Conclusions: Both progression-free and overall survival are related to FIGO staging and not to HPV infection. Nevertheless, the results are limited due to the small number of HPV-positive tumors observed in most series.
Category: Gynecologic & Obstetrics
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 136, Tuesday Afternoon