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919 Immunohistochemical expression of P16, P53, L1CAM and PD-L1 and the presence of HPV in primary biopsies of vulvar squamous cell carcinoma to predict groin node metastases
  1. Guus Veldmate
  1. Radboudumc, Nijmegen, The Netherlands


Introduction/Background In vulvar squamous cell carcinoma (VSCC) nodal status is highly relevant for treatment and outcome. Immunohistochemical (IHC) staining using p16 and p53 to distinguish the pathological pathway is routinely performed. Less utilized markers in VSCC like L1CAM, associated with metastases and poorer prognosis, and PD-L1, associated with immunosuppressive environment, might be of predictive value for the occurrence of groin node metastases.

We investigated the prognostic value of IHC expression and the presence of human papilloma virus (HPV) in primary biopsy specimen to predict groin node metastases.

Methodology Patients with macroinvasive VSCC undergoing primary surgical treatment between 2005–2015 were selected in the Gynaecological Oncology Center South (GOCS) in the Netherlands. Pathological revision was performed for both the primary biopsy as well as the final resection. IHC staining with p16, p53, L1CAM and PD-L1 was performed on all biopsies as well as detection of HPV.

Results Within this cohort of 124 patients, 32.3% were diagnosed with groin node metastases. Based on HPV presence and IHC expression with p16/p53, three groups were defined: HPV+ (n=16, 12.9%), HPV-/p53mutant (n=91, 73.4%) and HPV-/p53wildtype (n=17, 13.7%). Groin node metastases were observed in 31.3% of the HPV+ group, 33.0% of the HPV-/mutant group, and 23.5% of the HPV-/P53wildtype group.

Staining with L1CAM/PD-L1 showed no significant difference with groin node metastases in the HPV-/p53mutant group and positive or negative expression of L1CAM (32.0% vs 31.8%) or PD-L1 (30.8% vs 32.1%). In the HPV+ subgroup, the highest percentage of groin node metastases was associated with positive L1CAM (n=3, 66.7%) or PD-L1 (n=1, 100%) expression. In the HPV-/p53wildtype group, the lowest percentage of groin node metastases was objectified with negative expression for L1CAM (16.7%) or PD-L1 (14.3%).

Conclusion Allocating patients depending on HPV status and L1CAM/PD-L1 expression at time of primary biopsy could be valuable for risk stratification for groin node metastases.

Disclosures None

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