Chen Xiangyu, Song Shuang, Shi Haiyan, Lu Bingjian
Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Department of Surgical Pathology, Zhejiang Provincial Traditional Chinese Medicine Hospital, Hangzhou, Zhejiang Province, China.
Virchows Arch. 2025 May 10. doi: 10.1007/s00428-025-04123-4.
The tumor budding and tumor cell nest size-based (TBNS) grading scheme is an emerging prognostic indicator for squamous cell carcinoma (SCC) across various organs; however, its significance in vulvar SCC (VSCC) remains poorly investigated. In this study, we applied the TBNS grading system to an institutional cohort of 62 consecutive surgically resected VSCC cases (39 HPV-independent and 23 HPV-associated), excluding patients with neoadjuvant chemotherapy or FIGO stage IA disease. High tumor budding activity, small cell nest size, and high TBNS grade were significantly associated with reduced overall survival (OS) and disease-free survival (DFS) in VSCC, as well as with adverse clinicopathologic features such as lymphovascular space invasion, perineural involvement, lymph node metastasis, and advanced FIGO stage (p < 0.05). Multivariate analysis revealed that TBNS grade 3 was independently associated with reduced DFS (p < 0.05). In contrast, among the two conventional grading systems, only the Gynecology Oncology Group grading system showed a significant association with OS in univariate analysis (p < 0.05), but not in multivariate analysis (p > 0.05). We conclude that the TBNS grading system is a promising prognostic indicator for VSCC, outperforming conventional grading systems. Further validation in larger cohorts is needed to expand the clinical applicability of this grading system in VSCC.
基于肿瘤芽生和肿瘤细胞巢大小（TBNS）的分级方案是一种新兴的跨器官鳞状细胞癌（SCC）预后指标；然而，其在外阴鳞状细胞癌（VSCC）中的意义仍研究不足。在本研究中，我们将TBNS分级系统应用于一个机构队列，该队列包含62例连续接受手术切除的VSCC病例（39例HPV非依赖性和23例HPV相关性），排除接受新辅助化疗或FIGO IA期疾病的患者。高肿瘤芽生活性、小细胞巢大小和高TBNS分级与VSCC患者的总生存期（OS）和无病生存期（DFS）降低显著相关，也与诸如淋巴血管间隙浸润、神经周围侵犯、淋巴结转移和晚期FIGO分期等不良临床病理特征相关（p<0.05）。多因素分析显示，TBNS 3级与DFS降低独立相关（p<0.05）。相比之下，在两种传统分级系统中，只有妇科肿瘤学组分级系统在单因素分析中显示与OS显著相关（p<0.05），但在多因素分析中无显著相关性（p>0.05）。我们得出结论，TBNS分级系统是VSCC一种有前景的预后指标，优于传统分级系统。需要在更大队列中进一步验证，以扩大该分级系统在VSCC中的临床应用。
