The impact of HPV infection on risk of progression and overall mortality in vulvar squamous cell carcinoma: a retrospective single-center analysis

Author Info

Arsenio Spinillo Anna Daniela Iacobone Antonietta Mira Barbara Gardella Fabio Bottari Fabio Landoni Paola Alberizzi Stefania Cesari Stefano Bogliolo

Corresponding Author

Anna Daniela Iacobone
Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy

A B S T R A C T

Aims: To investigate the impact of Human Papillomavirus (HPV) infection on clinic and histopathologic characteristics, and prognostic factors of patients affected by vulvar squamous cell carcinoma (VSCC). Methods: Fifty-six patients diagnosed with VSCC at the IRCCS Fondazione Policlinico San Matteo, Pavia, Italy, from March 2001 to February 2016, were enrolled in a retrospective analysis. HPV DNA was detected by the INNO-LiPA HPV genotyping assay, version EXTRA II, on corresponding pathological specimens. Clinic and histopathologic characteristics were compared through Fisher's exact test. Kaplan–Meier survival curves and Cox regression models were used to analyze prognostic factors. Results: According to the Kaplan–Meier curves, no differences were found neither in Disease Free Survival (DFS) (p=0.221), nor in Overall Survival (OS) (p=0.135) between HPV-positive and HPV-negative patients. At Cox multivariate analysis, lymph node metastasis and positive surgical margins were significantly associated to higher risk of progression/relapse. This association was retained but decreased by lymph node metastasis (HR=5.92, 95% CI: 2.16 – 16.23; p<0.001) and positive surgical margins (HR=3.10, 95% CI: 1.13 – 6.50; p=0.028) in case of HPV-positivity, that was instead related to lower risk of disease progression/relapse (HR=0.31, 95% CI: 0.13 – 0.75; p=0.009). Age ≥ 75 years, lymph node metastasis and adjuvant radiotherapy were statistically associated to higher mortality rate. A significant reducing effect on mortality was shown adjusting HPV for lymph node extracapsular spread (HR=0.38, 95% CI: 0.16-0.88; p=0.025), and FIGO stage > I (HR=0.42, 95% CI: 0.19 – 0.95; p=0.037), that, instead, related to higher risk of death for any cause (HR=4.46, 95% CI: 1.51 – 13.19; p=0.007 and HR=2.53, 95% CI: 1.12 – 5.73; p=0.026, respectively). Conclusions: Risk of progression is reduced in HPV-positive patients with node metastasis and positive surgical margins. Overall, HPV infection has a protective effect on mortality in case of node extracapsular spread or FIGO stage > I.

Article Info

Article Type

Research Article

Publication history

Received: Tue 29, Jan 2019
Accepted: Sat 16, Feb 2019
Published: Mon 25, Feb 2019

Copyright

© 2023 Anna Daniela Iacobone. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.JSO.2019.01.003