Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Montebello, N-0310, Oslo, Norway.
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, N-0316, Oslo, Norway.
Virchows Arch. 2024 Jun;484(6):951-963. doi: 10.1007/s00428-023-03670-y. Epub 2023 Oct 16.
The objective of this study was to identify clinicopathologic parameters associated with disease outcome in FIGO stage I vulvar squamous cell carcinoma (vSqCC). The cohort consisted of 126 patients diagnosed with vSqCC in the period 2006-2016 who underwent primary vulvar surgery and evaluation of groin lymph node status. Tumors were reviewed by an experienced gynecologic pathologist. p16 and p53 protein expression by immunohistochemistry and HPV status were analyzed in 116 tumors. Clinicopathologic parameters, protein expression and HPV status were analyzed for association with progression-free and overall survival (PFS, OS). p16 expression and aberrant p53 were found in 49 (42%) and 61 (53%) tumors, respectively. Sixty-six tumors were HPV-associated (57%). Relapse was diagnosed in 35/126 (28%) of patients, and 23 (18%) died of disease. Tumor diameter > 4 cm (p = 0.013), lymphovascular space invasion (LVSI; p < 0.001), the presence of lichen sclerosus (p = 0.019), p16 expression (p = 0.007), p53 expression (p = 0.012), HPV status (p = 0.021), lymph node metastasis (p < 0.001) and post-operative radiotherapy (p < 0.001) were significantly related to OS in univariate analysis. Tumor diameter > 4 cm (p = 0.038), LVSI (p = 0.003), the presence of lichen sclerosus (p = 0.004), p16 expression (p = 0.004), HPV status (p = 0.039), lymph node metastasis (p < 0.001) and post-operative treatment (p < 0.001), were significantly related to PFS in univariate analysis. Age, BMI and surgical resection involvement were not significantly associated with OS or PFS. In multivariate Cox analysis, LVSI and p16 expression were independent prognosticators of OS (p < 0.001 and p = 0.02, respectively) and PFS (p = 0.018, p = 0.037). In conclusion, LVSI and p16 expression are independent prognostic factors in stage I vSqCC.
本研究的目的是确定与国际妇产科联盟（FIGO）Ⅰ期外阴鳞状细胞癌（vSqCC）疾病结局相关的临床病理参数。该队列包括 126 名 2006 年至 2016 年间在我院接受原发性外阴手术和腹股沟淋巴结状态评估的 vSqCC 患者。肿瘤由一名经验丰富的妇科病理学家进行评估。116 例肿瘤分析 p16 和 p53 蛋白表达及 HPV 状态。分析临床病理参数、蛋白表达和 HPV 状态与无进展生存期（PFS）和总生存期（OS）的关系。分别有 49 例（42%）和 61 例（53%）肿瘤出现 p16 表达和异常 p53。66 例肿瘤与 HPV 相关（57%）。126 例患者中有 35 例（28%）诊断为复发，23 例（18%）死于疾病。肿瘤直径>4cm（p=0.013）、淋巴血管间隙浸润（LVSI；p<0.001）、存在硬化性苔藓（p=0.019）、p16 表达（p=0.007）、p53 表达（p=0.012）、HPV 状态（p=0.021）、淋巴结转移（p<0.001）和术后放疗（p<0.001）在单因素分析中与 OS 显著相关。肿瘤直径>4cm（p=0.038）、LVSI（p=0.003）、存在硬化性苔藓（p=0.004）、p16 表达（p=0.004）、HPV 状态（p=0.039）、淋巴结转移（p<0.001）和术后治疗（p<0.001）在单因素分析中与 PFS 显著相关。年龄、BMI 和手术切除范围与 OS 或 PFS 无显著相关性。多因素 Cox 分析显示，LVSI 和 p16 表达是 OS（p<0.001 和 p=0.02）和 PFS（p=0.018，p=0.037）的独立预后因素。总之，LVSI 和 p16 表达是Ⅰ期 vSqCC 的独立预后因素。
