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Prognostic significance of lymph node variables and human papillomavirus DNA in invasive vulvar carcinoma.
Gynecol Oncol. 2004 Mar; 92(3):856-65.GO

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.

Authors+Show Affiliations

Department of Pathology, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, PR, Brazil. alvaropi@bsi.com.brNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14984953

Citation

Pinto, Alvaro P., et al. "Prognostic Significance of Lymph Node Variables and Human Papillomavirus DNA in Invasive Vulvar Carcinoma." Gynecologic Oncology, vol. 92, no. 3, 2004, pp. 856-65.
Pinto AP, Schlecht NF, Pintos J, et al. Prognostic significance of lymph node variables and human papillomavirus DNA in invasive vulvar carcinoma. Gynecol Oncol. 2004;92(3):856-65.
Pinto, A. 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), 856-65.
Pinto AP, et al. Prognostic Significance of Lymph Node Variables and Human Papillomavirus DNA in Invasive Vulvar Carcinoma. Gynecol Oncol. 2004;92(3):856-65. PubMed PMID: 14984953.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic significance of lymph node variables and human papillomavirus DNA in invasive vulvar carcinoma. AU - Pinto,Alvaro P, AU - Schlecht,Nicolas F, AU - Pintos,Javier, AU - Kaiano,Jane, AU - Franco,Eduardo L, AU - Crum,Christopher P, AU - Villa,Luisa L, PY - 2003/07/15/received PY - 2004/2/27/pubmed PY - 2004/4/14/medline PY - 2004/2/27/entrez SP - 856 EP - 65 JF - Gynecologic oncology JO - Gynecol. Oncol. VL - 92 IS - 3 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. SN - 0090-8258 UR - https://www.unboundmedicine.com/medline/citation/14984953/Prognostic_significance_of_lymph_node_variables_and_human_papillomavirus_DNA_in_invasive_vulvar_carcinoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090825803008606 DB - PRIME DP - Unbound Medicine ER -