title: Prognostic value and clinicopathologic characteristics of L1 cell adhesion molecule (L1CAM) in a large series of vulvar squamous cell carcinomas.
abstract: BACKGROUND
  Vulvar cancer treatment is mostly curative, but also has high morbidity rates. In a search for markers that can identify patients at risk of metastases, we investigated the prognostic value of L1-cell adhesion molecule (L1CAM) in large series of vulvar squamous cell carcinomas (VSCCs). L1CAM promotes cell motility and is an emerging prognostic factor for metastasis in many cancer subtypes.
  
  
  RESULTS
  L1CAM expression was observed at the invasive front or in spray-patterned parts of 17% of the tumours. L1CAM-positive tumours expressed vimentin more often, but L1CAM expression was not associated with TP53 or CTNNB1 mutations. Five-year survival was worse for patients with L1CAM expression (overall survival 46.1% vs 63.6%, P=.014, disease specific survival 63.8% vs 80.0%, P=.018). Multivariate analysis indicates L1CAM expression as an independent prognostic marker (HR 2.9, 95% CI 1.10-7.68). An in vitro spheroid invasion assay showed decreased invasion of L1CAM-expressing VSCC spindle cells after treatment with L1CAM-neutralising antibodies.
  
  
  METHODS
  Paraffin-embedded tumour tissue from two cohorts (N=103 and 245) of primary VSCCs were stained for L1CAM, vimentin and E-cadherin. Patients of the first cohort were tested for human papilloma virus infection and sequenced for TP53 and CTNNB1 (β-catenin) mutations. The expression of L1CAM was correlated to clinical characteristics and patient survival.
  
  
  CONCLUSIONS
  This is the first study to show high L1CAM-expression at the infiltrating margin of VSCC's. L1CAM-expressing VSCCs had a significantly worse prognosis compared to L1CAM-negative tumours. The highest expression was observed in spindle-shaped cells, where it might be correlated to their invasive capacity.
authors.affiliation: Department of Pathology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: Marjolijn D
authors.initials: MD
authors.lastname: Trietsch
authors.affiliation: Department of Gynaecology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
authors.forename: Maaike H M
authors.initials: MH
authors.lastname: Oonk
authors.affiliation: Gastroenterology-Hepatology and Molecular Cell Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: Lukas J A C
authors.initials: LJ
authors.lastname: Hawinkels
authors.affiliation: Gastroenterology-Hepatology and Molecular Cell Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Bor
authors.affiliation: Department of Pathology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: Jaap D H
authors.initials: JD
authors.lastname: van Eendenburg
authors.affiliation: Institute for Pathology and Parasitology, Bulgarian Academy of Sciences, 1040 Sofia, Bulgaria.
authors.forename: Zina
authors.initials: Z
authors.lastname: Ivanova
authors.affiliation: Department of Gynaecology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: Alexander A W
authors.initials: AA
authors.lastname: Peters
authors.affiliation: Department of Gynaecology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
authors.forename: Hans W
authors.initials: HW
authors.lastname: Nijman
authors.affiliation: Department of Gynaecology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: Katja N
authors.initials: KN
authors.lastname: Gaarenstroom
authors.affiliation: Department of Pathology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: Tjalling
authors.initials: T
authors.lastname: Bosse
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology*; D039842:Neural Cell Adhesion Molecule L1 / Q000378:metabolism*; D011379:Prognosis; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000378:metabolism / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; D039842:Neural Cell Adhesion Molecule L1
keywords: L1 cell adhesion molecule; L1CAM; squamous cell carcinoma; survival; vulvar cancer