人类乳头瘤病毒和p53状态可定义三种具有不同临床、病理和预后特征的阴道鳞状细胞癌类型。
Human papillomavirus and p53 status define three types of vulvar squamous cell carcinomas with distinct clinical, pathological, and prognostic features.
发表日期：2023 Apr 26
作者：
Nuria Carreras-Dieguez, Adela Saco, Marta Del Pino, Lorena Marimon, Ricardo López Del Campo, Carolina Manzotti, Pere Fusté, Clàudia Pumarola, Aureli Torné, Adriana Garcia, Natalia Rakislova
来源：
HISTOPATHOLOGY
摘要：
基于与人类乳头状瘤病毒（HPV）的病因关系，2020年世界卫生组织（WHO）分类将阴道鳞状细胞癌（VSCC）分为两种不同类型，即HPV相关和HPV非相关，而HPV非相关的肿瘤最近又根据p53状态进行了划分。然而，这种分类的临床和预后意义尚未得到明确的确立。我们在大量患者的系列中分析了这三种类型的VSCC的临床、病理和行为特征差异。分析了西班牙巴塞罗那医院举行的47年期间（1975年1月至2022年1月）进行初次手术的患者的VSCC样本（n = 190）。对HPV检测、p16和p53免疫组化染色进行了评估。我们还分析了复发无病生存（RFS）和疾病特异性生存（DSS）。33个肿瘤（17.4％）是HPV相关的，157个（82.6％）是HPV非相关的。其中，20个正常，137个异常表达p53。在多元分析中，这两种HPV非相关肿瘤的RFS更差（危险比[HR] = 3.63；P = 0.023，对于HPV非相关p53正常VSCC和HR = 2.78，P = 0.028，对于HPV非相关p53异常VSCC）。虽然差异不显著，但HPV非相关VSCC的DSS比HPV相关VSCC差。尽管HPV非相关p53正常肿瘤的患者的RFS较HPV非相关p53异常肿瘤的患者的差，但前者组的DSS较好。在多元分析中，只有晚期国际妇产科联合会（FIGO）阶段与更差的DSS有关（HR = 2.83；P = 0.010）。HPV和p53状态的关联具有预后意义，强调了VSCC的三级分子分类（HPV相关VSCC，HPV非相关p53正常VSCC，HPV非相关p53异常VSCC）。 © 2023 The Authors. Histopathology published by John Wiley & Sons Ltd.
Based on their etiological relationship with human papillomavirus (HPV), the 2020 WHO classification has divided vulvar squamous cell carcinomas (VSCC) into two distinct types, HPV-associated and HPV-independent, and HPV-independent tumours have recently been divided according to p53 status. Nevertheless, the clinical and prognostic significance of this classification has not been clearly established. We analysed the differential clinical, pathological, and behavioural characteristics of these three types of VSCC in a large series of patients.VSCC samples from patients who underwent primary surgery at the Hospital Clinic of Barcelona, Spain, during a 47-year period (January 1975 to January 2022) were analysed (n = 190). HPV detection, p16, and p53 immunohistochemical staining were evaluated. We also analysed recurrence-free survival (RFS) and disease-specific survival (DSS). Thirty-three tumours (17.4%) were HPV-associated and 157 (82.6%) HPV-independent. Of these, 20 showed normal and 137 abnormal p53 expression. The two types of HPV-independent tumours showed worse RFS in the multivariate analysis (hazard ratio [HR] = 3.63; P = 0.023 for the HPV-independent p53 normal VSCC and HR = 2.78; P = 0.028 for the HPV-independent p53 abnormal VSCC). Although the differences were not significant, HPV-independent VSCC had worse DSS than HPV-associated VSCC. Although patients with HPV-independent p53 normal tumours had worse RFS than patients with HPV-independent p53 abnormal tumours, the DSS was better for the former group. Only advanced FIGO stage was associated with worse DSS in multivariate analysis (HR = 2.83; P = 0.010).The association of HPV and p53 status have prognostic implications, reinforcing a three-tier molecular classification of VSCC (HPV-associated VSCC, HPV-independent VSCC with normal p53, HPV-independent VSCC with abnormal p53).© 2023 The Authors. Histopathology published by John Wiley & Sons Ltd.