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Vulvar cancer: Two pathways with different localization and prognosis.

F Hinten1, A Molijn2, L Eckhardt1

  • 1Department of Obstetrics and Gynecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

Gynecologic Oncology
|March 21, 2018
PubMed
Summary

Human papillomavirus (HPV)-related vulvar squamous cell carcinoma (SCC) is often found on the perineum and has a better prognosis than non-HPV-related vulvar SCC. This suggests HPV-related vulvar SCC is a distinct disease entity.

Keywords:
Disease specific survivalEtiologyHPVHuman papillomavirusPrognosisTumor localizationVulvar cancerp16(INK4a) expression

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Area of Science:

  • Gynecologic Oncology
  • Pathology
  • Virology

Background:

  • Vulvar squamous cell carcinoma (SCC) has two main origins: lichen sclerosus/differentiated vulvar intraepithelial neoplasia, or high-risk human papillomavirus (HPV) infection.
  • Understanding the distinct characteristics of HPV-related versus non-HPV-related vulvar SCC is crucial for patient management.

Purpose of the Study:

  • To compare the anatomical predilection sites and survival outcomes of HPV-related and non-HPV-related vulvar SCC.
  • To investigate whether HPV status influences the prognosis of vulvar SCC.

Main Methods:

  • Retrospective analysis of 318 patients with primary vulvar SCC treated between 1988 and 2015.
  • HPV testing using SPF10/DEIA/LiPA25 assay and p16INK4a staining to classify tumors as HPV-related or non-HPV-related.
  • Comparison of tumor location, disease-specific survival (DSS), disease-free survival (DFS), and overall survival (OS) between the two groups.

Main Results:

  • Out of 318 patients, 55 (17%) had HPV-related vulvar SCC and 263 (83%) had non-HPV-related vulvar SCC.
  • HPV-related SCCs were significantly more often located on the perineum (30%) compared to non-HPV-related SCCs (14%).
  • Patients with HPV-related vulvar SCC demonstrated significantly better DSS, DFS, and OS than those with non-HPV-related SCC.

Conclusions:

  • HPV-related vulvar SCC frequently occurs on the perineum and is associated with a favorable prognosis.
  • The anatomical location and HPV association may contribute to the improved survival observed in HPV-related vulvar SCC.
  • HPV-related vulvar SCC appears to be a distinct clinicopathological entity.