Prognostic significance of lymph node variables and human papillomavirus DNA in invasive vulvar carcinoma

Álvaro P. Pinto, Nicolas F. Schlecht, Javier Pintos, Jane Kaiano, Eduardo L. Franco, Christopher P. Crum, Luisa L. Villa

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objective. The present study investigates the influence of lymph node pathological features and HPV DNA status on the prognosis of vulvar invasive tumors. Methods. This study includes 184 consecutive cases of primary invasive squamous cell carcinoma of the vulva treated by radical surgery from 1975 to 1992, in São Paulo, Brazil. Clinical follow-up data was collected from patient files and hematoxilin-eosin sections were reviewed. HPV detection and typing was done by polymerase chain reaction (PCR), using specific and generic primers, followed by dot blot hybridization (DBH) with type-specific oligonucleotide probes for 19 HPV types. Age-adjusted Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze the cancer risk associations for all DNA and pathology-related variables. Results. Among 161 cases tested by PCR, 38 (23.6%) were positive for high-risk HPV types. Regional lymph nodes of 43 cases, including all those of HPV-positive tumors and a sample of the ones removed from patients with HPV negative tumors, were evaluated by the same method. HPV DNA was found in the lymph nodes of 10 cases. In every case, at least one lymph node was metastatic and the HPV detected in the lymph nodes were of the same type as those found in the primary tumor in all cases. Multivariate analysis including age, race, pattern of invasion, tumor thickness, inflammatory reaction, surgical margins, number of node metastases, presence of extracapsular growth, depth of invasion, and presence of high-risk HPV DNA was performed. Following automated selections of this model, node variables important for prognosis that remained were number of node metastases and presence of extracapsular growth. Conclusions. Patients with four or more node metastases associated with extracapsular spread were 5.6 (95%CI: 2.3-13.1) times more likely to die from cancer and 10.0 (95%CI: 4.0-24.9) times more likely to have a recurrence than patients without metastases. The HPV status in the tumor was not important as a prognostic factor.

Original languageEnglish (US)
Pages (from-to)856-865
Number of pages10
JournalGynecologic Oncology
Volume92
Issue number3
DOIs
StatePublished - Mar 2004
Externally publishedYes

Fingerprint

Lymph Nodes
Carcinoma
DNA
Neoplasms
Neoplasm Metastasis
Polymerase Chain Reaction
Vulva
Oligonucleotide Probes
Kaplan-Meier Estimate
Eosine Yellowish-(YS)
Growth
Proportional Hazards Models
Brazil
Squamous Cell Carcinoma
Multivariate Analysis
Pathology
Recurrence

Keywords

  • Extracapsular growth
  • Histopathology
  • Human papillomavirus
  • Positive lymph nodes
  • Recurrence
  • Squamous cell carcinoma of the vulva
  • Survival
  • Vulvar cancer

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Pinto, Á. P., Schlecht, N. F., Pintos, J., Kaiano, J., Franco, E. L., Crum, C. P., & Villa, L. L. (2004). Prognostic significance of lymph node variables and human papillomavirus DNA in invasive vulvar carcinoma. Gynecologic Oncology, 92(3), 856-865. https://doi.org/10.1016/j.ygyno.2003.11.052

Prognostic significance of lymph node variables and human papillomavirus DNA in invasive vulvar carcinoma. / Pinto, Álvaro P.; Schlecht, Nicolas F.; Pintos, Javier; Kaiano, Jane; Franco, Eduardo L.; Crum, Christopher P.; Villa, Luisa L.

In: Gynecologic Oncology, Vol. 92, No. 3, 03.2004, p. 856-865.

Research output: Contribution to journalArticle

Pinto, ÁP, Schlecht, NF, Pintos, J, Kaiano, J, Franco, EL, Crum, CP & Villa, LL 2004, 'Prognostic significance of lymph node variables and human papillomavirus DNA in invasive vulvar carcinoma', Gynecologic Oncology, vol. 92, no. 3, pp. 856-865. https://doi.org/10.1016/j.ygyno.2003.11.052
Pinto, Álvaro P. ; Schlecht, Nicolas F. ; Pintos, Javier ; Kaiano, Jane ; Franco, Eduardo L. ; Crum, Christopher P. ; Villa, Luisa L. / Prognostic significance of lymph node variables and human papillomavirus DNA in invasive vulvar carcinoma. In: Gynecologic Oncology. 2004 ; Vol. 92, No. 3. pp. 856-865.
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abstract = "Objective. The present study investigates the influence of lymph node pathological features and HPV DNA status on the prognosis of vulvar invasive tumors. Methods. This study includes 184 consecutive cases of primary invasive squamous cell carcinoma of the vulva treated by radical surgery from 1975 to 1992, in S{\~a}o Paulo, Brazil. Clinical follow-up data was collected from patient files and hematoxilin-eosin sections were reviewed. HPV detection and typing was done by polymerase chain reaction (PCR), using specific and generic primers, followed by dot blot hybridization (DBH) with type-specific oligonucleotide probes for 19 HPV types. Age-adjusted Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze the cancer risk associations for all DNA and pathology-related variables. Results. Among 161 cases tested by PCR, 38 (23.6{\%}) were positive for high-risk HPV types. Regional lymph nodes of 43 cases, including all those of HPV-positive tumors and a sample of the ones removed from patients with HPV negative tumors, were evaluated by the same method. HPV DNA was found in the lymph nodes of 10 cases. In every case, at least one lymph node was metastatic and the HPV detected in the lymph nodes were of the same type as those found in the primary tumor in all cases. Multivariate analysis including age, race, pattern of invasion, tumor thickness, inflammatory reaction, surgical margins, number of node metastases, presence of extracapsular growth, depth of invasion, and presence of high-risk HPV DNA was performed. Following automated selections of this model, node variables important for prognosis that remained were number of node metastases and presence of extracapsular growth. Conclusions. Patients with four or more node metastases associated with extracapsular spread were 5.6 (95{\%}CI: 2.3-13.1) times more likely to die from cancer and 10.0 (95{\%}CI: 4.0-24.9) times more likely to have a recurrence than patients without metastases. The HPV status in the tumor was not important as a prognostic factor.",
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AU - Schlecht, Nicolas F.

AU - Pintos, Javier

AU - Kaiano, Jane

AU - Franco, Eduardo L.

AU - Crum, Christopher P.

AU - Villa, Luisa L.

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N2 - Objective. The present study investigates the influence of lymph node pathological features and HPV DNA status on the prognosis of vulvar invasive tumors. Methods. This study includes 184 consecutive cases of primary invasive squamous cell carcinoma of the vulva treated by radical surgery from 1975 to 1992, in São Paulo, Brazil. Clinical follow-up data was collected from patient files and hematoxilin-eosin sections were reviewed. HPV detection and typing was done by polymerase chain reaction (PCR), using specific and generic primers, followed by dot blot hybridization (DBH) with type-specific oligonucleotide probes for 19 HPV types. Age-adjusted Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze the cancer risk associations for all DNA and pathology-related variables. Results. Among 161 cases tested by PCR, 38 (23.6%) were positive for high-risk HPV types. Regional lymph nodes of 43 cases, including all those of HPV-positive tumors and a sample of the ones removed from patients with HPV negative tumors, were evaluated by the same method. HPV DNA was found in the lymph nodes of 10 cases. In every case, at least one lymph node was metastatic and the HPV detected in the lymph nodes were of the same type as those found in the primary tumor in all cases. Multivariate analysis including age, race, pattern of invasion, tumor thickness, inflammatory reaction, surgical margins, number of node metastases, presence of extracapsular growth, depth of invasion, and presence of high-risk HPV DNA was performed. Following automated selections of this model, node variables important for prognosis that remained were number of node metastases and presence of extracapsular growth. Conclusions. Patients with four or more node metastases associated with extracapsular spread were 5.6 (95%CI: 2.3-13.1) times more likely to die from cancer and 10.0 (95%CI: 4.0-24.9) times more likely to have a recurrence than patients without metastases. The HPV status in the tumor was not important as a prognostic factor.

AB - Objective. The present study investigates the influence of lymph node pathological features and HPV DNA status on the prognosis of vulvar invasive tumors. Methods. This study includes 184 consecutive cases of primary invasive squamous cell carcinoma of the vulva treated by radical surgery from 1975 to 1992, in São Paulo, Brazil. Clinical follow-up data was collected from patient files and hematoxilin-eosin sections were reviewed. HPV detection and typing was done by polymerase chain reaction (PCR), using specific and generic primers, followed by dot blot hybridization (DBH) with type-specific oligonucleotide probes for 19 HPV types. Age-adjusted Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze the cancer risk associations for all DNA and pathology-related variables. Results. Among 161 cases tested by PCR, 38 (23.6%) were positive for high-risk HPV types. Regional lymph nodes of 43 cases, including all those of HPV-positive tumors and a sample of the ones removed from patients with HPV negative tumors, were evaluated by the same method. HPV DNA was found in the lymph nodes of 10 cases. In every case, at least one lymph node was metastatic and the HPV detected in the lymph nodes were of the same type as those found in the primary tumor in all cases. Multivariate analysis including age, race, pattern of invasion, tumor thickness, inflammatory reaction, surgical margins, number of node metastases, presence of extracapsular growth, depth of invasion, and presence of high-risk HPV DNA was performed. Following automated selections of this model, node variables important for prognosis that remained were number of node metastases and presence of extracapsular growth. Conclusions. Patients with four or more node metastases associated with extracapsular spread were 5.6 (95%CI: 2.3-13.1) times more likely to die from cancer and 10.0 (95%CI: 4.0-24.9) times more likely to have a recurrence than patients without metastases. The HPV status in the tumor was not important as a prognostic factor.

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KW - Histopathology

KW - Human papillomavirus

KW - Positive lymph nodes

KW - Recurrence

KW - Squamous cell carcinoma of the vulva

KW - Survival

KW - Vulvar cancer

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