Introduction/Background The natural history of invasive vaginal cancer has been minimally investigated. We aimed to investigate HPV distribution and prognostic factors in vaginal cancer (VC).
Methodology We retrospectively reviewed medical records of patients with VC who received primary treatment between 1989 and 2020. 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.
Results A total of 73 vaginal carcinoma patients eligible for analysis. Medial follow-up time was 88.6 months (range 0.56–239.5 months). 66 patients (90.4%) were diagnosed as squamous cell carcinoma (SCC) and 7 (9.6%) as non-SCC. HPV DNA sequences were detected in 88.7% of SCC specimens, and 83.3% of non-SCC VC (P = 0.543). The leading types were HPV16 (51.7%), HPV52 (13.3%) and HPV58 (11.7%). HPV-positivity was associated with better 5-year cancer-specific survival (CSS) (70.8% vs 35.7%, P = 0.005). Because there was strong correlation between p16-positivity and HPV-positivity (P <0.001), they were alternatively entered in multivariate analysis. In both models, pelvic lymph node (PLN) metastasis (HR 4.72, 95%confidence interval [CI] 1.505–14.804, P = 0.008 or 6.35, 95%CI 1.871–21.564, P = 0.003) was a significant adverse predictor of CSS, while p16 (HR 0.049, 95%CI 0.01- 0.229, P <0.001) or HPV-positivity (HR 0.129, 95%CI 0.036–0.466, P = 0.002) was related to better prognosis. International Federation of Gynaecology and Obstetrics stage (III/IV vs I/II) was significant in univariate analysis, but was not significant in either model.
Conclusion PLN metastasis was a significant adverse predictor, while p16-positivity or HPV-positivity (alternatively) was a significant factor of better prognosis.
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