title: Distribution of human papillomavirus genotypes in invasive squamous carcinoma of the vulva.
abstract: Many studies have established a critical role for human papillomavirus (HPV) in the development of anogenital squamous neoplasia. In this report, we show the distribution of 37 high- and low-risk HPV types in 116 cases of invasive squamous vulvar carcinoma. Sections from paraffin-embedded tissue blocks were dissected as necessary to select areas of invasive carcinoma. Clinical and pathologic variables were analyzed using t-tests, univariate odds ratios and logistic regression analysis. Seventy percent of cases were HPV-positive, with an average patient age of 65 years (n=81). HPV-negative cases (n=35) had a higher average age (70 years), but these populations were not statistically different (t=1.65, P=0.10). HPV16 was most common (n=65). Other HPV types were less frequent (HPV33, n=12; HPV45, n=4; HPV52 and 6, each n=3; HPV18, 53 and 62, each n=2). Additional HPV types were identified only once. Multiple infections typically included HPV16 (12/14 cases). Tumors showing low-risk HPV (11 cases) and low-risk HPV only (three cases) were uncommon. Regional node metastasis was documented in 29 of 116 tumors, and 8/9 HPV-positive nodes contained HPV types identical to the primary tumor. Of tumor types, warty carcinoma was most strongly associated with high-risk HPV (odds ratio 4.34, 95% confidence interval 1.32-18.45), particularly high-risk HPVs other than type 16 (odds ratio 9.04, 95% confidence interval 1.60-54.00). Tumors associated with any HPV type (odds ratio 0.40, 95% confidence interval 0.14-1.17), any high-risk type (odds ratio 0.36, 95% confidence interval 0.12-1.08), or type 16 alone (odds ratio 0.34, 95% confidence interval 0.11-1.12) were less likely to metastasize than HPV-negative tumors. Correcting for possible confounding variables, such as patient age and tumor histology, linear logistic regression analysis confirmed this association (high-risk HPV odds ratio 0.28, 95% confidence interval 0.09-0.89).
authors.affiliation: Department of Pathology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Bobbie C
authors.initials: BC
authors.lastname: Sutton
authors.forename: Richard A
authors.initials: RA
authors.lastname: Allen
authors.forename: William E
authors.initials: WE
authors.lastname: Moore
authors.forename: S Terence
authors.initials: ST
authors.lastname: Dunn
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis*; D018450:Disease Progression; D005260:Female; D016679:Genome, Viral; D006801:Humans; D008207:Lymphatic Metastasis; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000473:pathology / Q000821:virology*; D014412:Tumor Virus Infections / Q000473:pathology / Q000821:virology*; D014846:Vulvar Neoplasms / Q000473:pathology / Q000821:virology*
chemical_list: D004279:DNA, Viral