Vulvar cancer: Two pathways with different localization and prognosis

• Published in: Gynecologic oncology Vol. 149; no. 2; pp. 310 - 317
• Main Authors: Hinten, F., Molijn, A., Eckhardt, L., Massuger, L.F.A.G., Quint, W., Bult, P., Bulten, J., Melchers, W.J.G., de Hullu, J.A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2018
• Subjects: Disease specific survival; Etiology; HPV; Human papillomavirus; p16INK4a expression; Prognosis; Tumor localization; Vulvar cancer; Human papillomavirus; Prognosis; Etiology; Tumor localization; Vulvar cancer; p16INK4a expression; Disease specific survival; HPV; p16(INK4a) expression
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2018.03.003

Two etiologic pathways for vulvar squamous cell carcinoma (SCC) are described: in a background of lichen sclerosus and/or differentiated vulvar intraepithelial neoplasia and related to high-risk human papillomavirus (HPV) infection with high grade squamous intraepithelial lesion (HSIL) as precursor. The aim was to compare the predilection site and survival of HPV-related to non HPV-related vulvar SCCs. Data of patients treated for primary vulvar SCC at the Radboudumc between March 1988 and January 2015 were analyzed. All histological specimens were tested for HPV with the SPF10/DEIA/LiPA25 system assay and p16INK4a staining was performed using CINtec® histology kit. Vulvar SCCs were considered HPV-related in case of either >25% p16INK4a expression and HPV positivity or >25% p16INK4a expression and HSIL next to the tumor without HPV positivity. Tumor localization, disease specific survival (DSS), disease free survival (DFS) and overall survival (OS) of patients with HPV-related and non HPV-related vulvar SCC were compared. In total 318 patients were included: 55 (17%) had HPV-related (Group 1) and 263 (83%) had non HPV-related vulvar SCC (Group 2). Tumors in Group 1 were significantly more often located at the perineum compared to Group 2, 30% and 14%, respectively (p=0.001). The DSS, DFS and OS were significantly better in HPV-related than in non HPV-related vulvar SCC patients. HPV-related vulvar SCCs are more frequently located at the perineum and have a favorable prognosis compared to non HPV-related vulvar SCCs. Both localization and HPV-relation could explain this favorable prognosis. HPV-related vulvar SCC seems to be a separate entity. •The p16INK4A expression should take leading role in determining HPV-relation.•HPV-related vulvar SCC has better prognosis and perineum as predilection site.•HPV-related vulvar SCC is a separate entity and other treatment modalities need to be investigated.