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HPV-independent and HPV-associated vulvar squamous cell carcinoma: two different cancers
  1. Lois Eva1,2,
  2. Lynn Sadler3,
  3. John MD Thompson3,
  4. Sukwinder Sahota1,
  5. Kah Leng Fong1,
  6. Ronald W Jones1 and
  7. Susan M Bigby4
  1. 1Gynaecological Oncology, National Women's Health, Auckland City Hospital, Auckland, New Zealand
  2. 2Gynaecological Oncology, University of Auckland, Auckland, New Zealand
  3. 3University of Auckland, Auckland, New Zealand
  4. 4Histopathology, Middlemore Hospital, Auckland, New Zealand
  1. Correspondence to Dr Lois Eva, Gynaecological Oncology, National Women's Health, Auckland City Hospital, Auckland, New Zealand; LoisE{at}adhb.govt.nz

Abstract

Objectives We report the disease-specific survival of patients with human papillomavirus (HPV)-associated and HPV-independent vulvar squamous cell carcinomas and determine whether differences exist and are independent of stage and age at diagnosis.

Methods This was a retrospective cohort study with case note and pathology slide review of 265 consecutive women with vulvar squamous cell carcinoma. These patients were treated over a 15 year period (2001–2016) at a centralized cancer center covering half the population of New Zealand. The women’s cancers were categorized dependent on their adjacent pathology, immunohistochemistry and HPV status following expert slide review. Disease-specific survival was calculated using Kaplan-Meier univariable and Cox proportional hazard (adjusting for stage, age, and HPV dependence) multivariable methods.

Results The survival analysis included 236 women with follow-up to 96 months; 124 of them were HPV-associated, 95 HPV-independent, and 17 were unclassifiable. Of the 236 women, 146 were stage 1 (92 HPV-associated, 49 HPV-independent, 5 unclassifiable), 13 stage II (7 HPV-associated, 6 HPV-independent), 62 stage III (20 HPV-associated, 34 HPV-independent, 8 unclassifiable) and 15 stage IV (5 HPV-associated, 6 HPV-independent, 4 unclassifiable). HPV-independent vulvar squamous cell carcinomas had significantly worse survival than HPV-associated vulvar squamous cell carcinomas independent of stage and age at diagnosis (HR 3.6 (95% confidence interval (CI): 1.6 to 8.2)). Tumors that were unclassifiable by HPV type also had significantly worse survival than HPV-associated tumors independent of stage and age at diagnosis (HR 6.2 (95% CI: 2.4 to 16.0)).

Conclusions HPV-independent vulvar squamous cell carcinomas present more frequently in older women than HPV-associated tumors. However, the poorer prognosis is independent of age and stage, with worse outcomes even in early stage disease.

  • vulvar and vaginal cancer
  • vulvar neoplasms

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors Study concept and design: LE, LS, SMB; Histopathological slide review and acquisition of pathology data: SMB; Acquisition of clinical data: LE, RWJ, KLF, SS; Data analysis, Statistical analysis and epidemiology: LS, JMDT; Manuscript writing: LE, LS, SMB, Critical review of manuscript: LE, SMB, LS, RWJ, KLF, SS, JMDT; Final approval of manuscript: LE, SMB, LS, RWJ, KLF, SS, JMDT. Guarantors: LE and LS.

  • Funding Block retrieval was funded by Cancer Research Trust NZ, New Zealand (previously Genesis Oncology).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.