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Study of Biomolecular and Clinical Prognostic Factors in Patients With Cancer of the Vulva Undergoing Surgical Treatment
  1. Paulo Henrique Zanvettor, MD*,
  2. Deraldo Fernando Falcão Filho, MD,
  3. Fernando Augusto Soares, PhD,
  4. Adson Roberto Santos Neves, MD and
  5. Leonardo Oliveira Palmeira, MD
  1. *Department of Gynecology Oncology, and
  2. Gynecologic Oncology Service, Hospital Aristides Maltez; and
  3. Department of Pathology, A.C. Camargo Cancer Center, Sao Paulo, Brazil.
  1. Address correspondence and reprint requests to Paulo Henrique Zanvettor, MD, Department of Gynecology Oncology, Hospital Aristides Maltez, Avenida Dom João VI número 332-Serviço de Ginecologia Oncológica-Departamento de Cirurgia Pelvica do Hospital Aristides Maltez, Bairro: Pituba, Salvador, Bahia, Brazil. Zip Code (CEP) 40285-001. E-mail:phzanvettor{at}


Introduction Cancers of the vulva account for 3% to 5% of all cancers of the female genital. This study was conducted to evaluate clinical, pathological, and molecular prognostic factors in patients with cancer of the vulva.

Methods Patients with squamous cell carcinoma of the vulva who had undergone surgical treatment at the Department of Pelvic Surgery and Gynecology Service, Aristides Maltez Hospital, between June 1993 and June 2011 were selected. Clinical, epidemiological, pathological, and molecular characteristics related to the prognosis of these patients were evaluated in relation to the prognosis. In the molecular evaluation, we studied the expression of p53 and matrix metalloproteinase 2 by immunohistochemistry.

Results Seventy-five patients were eligible for the study. In multivariable analysis, factors related to survival were as follows: tumor size larger than 4 cm (P = 0.014), an invasion depth greater than 2 mm (P = 0.023) and matrix metalloproteinase 2 expression in more than 50% of the tumor cells (P = 0.046). With the use of the relative risks of the factors identified in the multivariable analysis, a point count was developed for a prognostic classification (the score classifies patients into 3 categories).

Conclusions A tumor size larger than 4 cm, an invasion depth greater than 2 mm, and metalloproteinase 2 expression in more than 50% of the tumor cells seem to be related to lower overall survival rate in patients with cancer of the vulva undergoing surgical treatment. A classification of the patient’s prognosis can be performed using a point count based on these relative risks.

  • Vulvar neoplasms/pathology
  • Carcinoma
  • squamous cell/epidemiology
  • Tumor suppressor protein p53
  • Matrix metalloproteinase 2
  • Immunohistochemistry
  • Prognosis

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  • The authors declare no conflicts of interest.