Objectives Vulvar squamous cell carcinoma is subclassified into three prognostically relevant groups: (i) human papillomavirus (HPV) associated, (ii) HPV independent p53 abnormal (mutant pattern), and (iii) HPV independent p53 wild type. Immunohistochemistry for p16 and p53 serve as surrogates for HPV viral integration and TP53 mutational status. We assessed the reproducibility of the subclassification based on p16 and p53 immunohistochemistry and evaluated the prognostic significance of vulvar squamous cell carcinoma molecular subgroups in a patient cohort treated by vulvar field resection surgery.
Methods In this retrospective cohort study, 68 cases treated by vulvar field resection were identified from the Leipzig School of Radical Pelvic Surgery. Immunohistochemistry for p16 and p53 was performed at three different institutions and evaluated independently by seven pathologists and two trainees. Tumors were classified into one of four groups: HPV associated, HPV independent p53 wild type, HPV independent p53 abnormal, and indeterminate. Selected cases were further interrogated by (HPV RNA in situ hybridization, TP53 sequencing).
Results Final subclassification yielded 22 (32.4%) HPV associated, 41 (60.3%) HPV independent p53 abnormal, and 5 (7.3%) HPV independent p53 wild type tumors. Interobserver agreement (overall Fleiss’ kappa statistic) for the four category classification was 0.74. No statistically significant differences in clinical outcomes between HPV associated and HPV independent vulvar squamous cell carcinoma were observed.
Conclusion Interobserver reproducibility of vulvar squamous cell carcinoma subclassification based on p16 and p53 immunohistochemistry may support routine use in clinical practice. Vulvar field resection surgery showed no significant difference in clinical outcomes when stratified based on HPV status.
- Vulvar Neoplasms
- Gynecologic Surgical Procedures
Data availability statement
Data are available upon reasonable request.
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Contributors ET: investigation, data curation, visualization, writing-original draft, and funding acquisition. LH: writing-review and editing. AKH: investigation and data curation. AP: investigation. KT: investigation, and writing-review and editing. NT: investigation. JS: investigation. RR: investigation. SJ: investigation. AJ: writing-review and editing. JH: investigation, data curation, formal analysis, visualization, and writing-review and editing. JNM: writing-review and editing. CBG: conceptualization, methodology, investigation and guarantor, writing-review and editing, and supervision. MH: writing-review and editing. NS: conceptualization, methodology, investigation, data curation, writing-review and editing, and supervision. L-CH: conceptualization, methodology, investigation, data curation, writing-review and editing, and supervision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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