title: HPV status and favourable outcome in vulvar squamous cancer.
abstract: It is universally accepted that high-risk human papillomavirus (HR-HPV) is the cause of cervical dysplasia and cancer. More recently, it has been shown that HPV is also a marker of clinical outcome in oropharyngeal cancer. However, contemporary information is lacking on both the prevalence of HPV infection in vulvar cancer (VSCC), its precursor lesion, vulvar intraepithelial neoplasia (VIN) and the influence of HPV-status on the prognosis of this malignancy. We have conducted a detailed population-based study to examine rates of progression of VIN to VSCC, type-specific HPV prevalence in vulvar disease and the influence of HPV status on clinical outcome in VSCC. We observed that the age at which women are diagnosed with VSCC is falling and there is a significant time gap between first diagnosis of VIN and progression to invasive disease. HR-HPV infection was detected in 87% (97/112) cases of VIN and 52% cases (32/62) of VSCC. The presence of HR-HPV in squamous intraepithelial lesion was associated with lower rates of progression to invasive cancer (hazard ratio, 0.22, p = 0.001). In the adjusted analysis, HR-HPV was associated with improved progression-free survival of VSCC compared to those with HPV negative tumours (hazard ratio, 0.32, p = 0.02).
authors.affiliation: Sussex Cancer Centre, Brighton and Sussex University Hospital.|Institute of Cancer Sciences, University of Glasgow.
authors.forename: Katie
authors.initials: K
authors.lastname: Wakeham
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde.
authors.forename: Kim
authors.initials: K
authors.lastname: Kavanagh
authors.affiliation: Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh.
authors.forename: Kate
authors.initials: K
authors.lastname: Cuschieri
authors.affiliation: Department of Pathology, The Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde.
authors.forename: David
authors.initials: D
authors.lastname: Millan
authors.affiliation: Vaccine Preventable Diseases, Health Protection Scotland.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Pollock
authors.affiliation: Department of Pathology, The Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bell
authors.affiliation: Department of Gynaecological Oncology, Glasgow Royal Infirmary.
authors.forename: Kevin
authors.initials: K
authors.lastname: Burton
authors.affiliation: Beatson West of Scotland Cancer Centre, Glasgow.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Reed
authors.affiliation: MRC-University of Glasgow Centre for Virus Research, University of Glasgow.
authors.forename: Sheila V
authors.initials: SV
authors.lastname: Graham
mesh_terms: D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000401:mortality / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006801:Humans; D053208:Kaplan-Meier Estimate; D018459:Lichen Sclerosus et Atrophicus / Q000453:epidemiology / Q000821:virology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000401:mortality / Q000628:therapy / Q000821:virology*; D015995:Prevalence; D012606:Scotland / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000401:mortality / Q000628:therapy / Q000821:virology*
chemical_list: D004279:DNA, Viral
keywords: HPV; VIN; vulvar cancer