Squamous cell carcinoma of the vulva in Brazil: Prognostic importance of host and viral variables

Álvaro P. Pinto, Lisa B. Signorello, Christopher P. Crum, Bernard L. Harlow, Fauzer Abrão, Luisa L. Villa

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39 Scopus citations


Background. Certain clinicopathologic features of vulvar squamous cell carcinoma have been correlated with adverse prognosis. However, few large- scale studies have addressed their role in patient survival. This study examined the relationship between multiple variables and prognosis in a large group of vulvar cancers in Brazil. Methods. One hundred eighty-four Brazilian women with vulvar carcinoma were studied and the following variables recorded: age, pathologic TNM stage, survival, histologic grade, tumor histologic pattern, invasion pattern, tumor thickness, and tissue stromal and inflammatory response. Human papillomavirus (HPV) was detected by polymerase chain reaction amplification of extracted archival DNA. Data were analyzed using Cox proportional hazards modeling. Results. After controlling for age, the probability of cancer survival decreased with increasing age, stage, grade, and tumor thickness, a fibromyxoid stromal response, infiltrative growth pattern, and basaloid histologic pattern. With the exception of fibromyxoid stromal response, each of these variables remained prognostically significant after adjustment for several other predictors in a multivariate model. Women whose tumors displayed a basaloid pattern were 3.5 times as likely to die from cancer than those with keratinizing tumors [hazard ratio (HR) = 3.5, 95% CI(1.3-9.2)]. An infiltrative invasion pattern strongly increased the probability of cancer death [HR= 4.6, 95% CI(1.9,11.4)]. HPV status did not influence survival, despite its association with basaloid histology. Conclusions. Previously reported associations of negative HPV status and fibromyxoid response with adverse prognosis in vulvar cancer were not confirmed by multivariate analysis. Basaloid variants, and particularly diffusely infiltrative tumors, carry an adverse prognosis.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalGynecologic oncology
Issue number1
StatePublished - Jul 1999

Bibliographical note

Funding Information:
The authors are grateful to Dr. Eduardo L. Franco, McGill University, Montreal, Canada, for his assistance in the study design, and to Dr. Humberto Torloni, from the Hospital do Câncer, Fundac¸ão Antonio Prudente, São Paulo, Brazil, who assisted in the search and evaluation of pathologic specimens. A.P.P. is a recipient of a fellowship from the Fundac¸ão de Amparo a Pesquisa do Estado de São Paulo (95/2535-9) as part of his Ph.D. program at the Pathology Department of the University of São Paulo, Brazil.


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