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171 Human papillomavirus genotype and long-term clinical outcomes of vulvar malignancies
  1. H Tung1,
  2. Y Tang1,
  3. L Yang2,
  4. H Huang1,
  5. R Wu3,
  6. Y Pan2,
  7. S Jung3,
  8. C Lin1,
  9. C Wang4,
  10. A Chao1,
  11. M Chen1,
  12. W Chen1,
  13. K Huang1,
  14. TC Chang1 and
  15. CH Lai1
  1. 1Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taiwan
  2. 2Clinical Trial Center, Chang Gung Memorial Hospital Linkou Branch, Taiwan
  3. 3Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
  4. 4Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan

Abstract

Objectives To analyze prevalence of HPV DNA, HPV genotype distribution, prognostic factors and long-term outcomes of vulvar carcinoma.

Methods We retrospectively reviewed medical records of patients with vulvar carcinoma who received primary surgeries between 1985 and 2014 in a single institution. General polymerase chain reaction (PCR) SPF1/GP6+ followed by revert-blot detection was performed for human papillomavirus (HPV) genotyping. E6 type-specific PCR of the top-5 prevalent types was performed to reconfirm HPV-negative status. P16INK4a immunohistochemistry staining was performed. Univariate and multivariate analyses were performed to identify predictors of clinical outcomes of squamous cell carcinomas (SCCs).

Results A total of 150 vulvar carcinoma patients eligible for analysis were retrieved. Medial follow up time was 71.4 months (0.2–341.8 months). One hundred and twenty-nine patients (86.0%) were diagnosed as SCC. In SCC specimens, HPV DNA sequences were detected in 56.6%, and 14.3% of non-SCC vulvar cancer (n = 21) were HPV positive. The leading 4 types were HPV16 (54.0%), HPV58 (15.8%), HPV52 (6.6%), and HPV18 (5.3%). HPV-positivity was associated with better 5-year cancer-specific survival (CSS) (P = 0.037). In multivariable analysis, older age (continuous, hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03–1.08, P <0.001), advanced International Federation of Gynecology and Obstetrics (FIGO) stage (III-IV vs I-II, HR 3.86 95%CI 2.01–7.42, P <0.001) were independent adverse predictors of CSS, while p16-positivity (0.36, 95%CI 0.19–0.69, P =0.002) was related to better prognosis.

Conclusion Advanced FIGO stage and older age were significant adverse predictors, while p16-positivity was a significant factor of better prognosis.

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