Differentiated vulvar intraepithelial neoplasia long-term follow up and prognostic factors: An analysis of a large historical cohort.
differentiated vulvar intraepithelial neoplasia
oncology
topical corticosteroid therapy
vulvar cancer
vulvar intraepithelial neoplasia
Journal
Acta obstetricia et gynecologica Scandinavica
ISSN: 1600-0412
Titre abrégé: Acta Obstet Gynecol Scand
Pays: United States
ID NLM: 0370343
Informations de publication
Date de publication:
21 Feb 2024
21 Feb 2024
Historique:
revised:
12
01
2024
received:
05
10
2023
accepted:
06
02
2024
medline:
22
2
2024
pubmed:
22
2
2024
entrez:
21
2
2024
Statut:
aheadofprint
Résumé
Differentiated vulvar intraepithelial neoplasia (dVIN) is a high-risk preinvasive vulvar lesion and precursor of human papillomavirus-independent vulvar squamous cell carcinoma (VSCC). Due to its rarity, literature data on its malignant potential are scant. The aim of the study is to assess the risk of developing VSCC in patients surgically treated for dVIN not associated with VSCC (solitary dVIN) and the risk of VSCC recurrence in patients treated for dVIN associated with VSCC (dVIN-VSCC) at first diagnosis. A historical cohort study was performed in a northern Italy referral center for vulvar neoplasms. All consecutive women surgically treated for histologically confirmed dVIN from 1994 to 2021 were collected. Primary outcome was cancer risk or recurrent cancer risk, secondary outcomes were risk factors associated with VSCC development or recurrence. Kaplan-Meier method and log-rank test were used to estimate cancer risk or recurrent cancer risk differences and uni- and multivariate Cox regression analyses to identify risk factors associated with VSCC development in solitary dVIN and recurrence of dVIN-VSCC. Seventy-six patients with dVIN at preoperative biopsy were included: at excisional specimens 44 were solitary dVIN and 32 were dVIN-VSCC. The absolute risk of VSCC development after solitary dVIN treatment was 43.2% with median time to to VSCC diagnosis of 25.4 months (range 3.5-128.0 months). VSCC recurrence absolute risk in treated dVIN-VSCC patients was 31.3% with median time to VSCC recurrence of 52.9 months (range 6.5-94.8 months). At uni- and multivariate regression analyses, only compliant topical ultrapotent corticosteroid treatment after solitary dVIN excision showed an ability to prevent VSCC development. No protective effect by corticosteroid treatment was shown for VSCC recurrence in dVIN-VSCC patients. Smoking was associated with higher cancer recurrence risk in dVIN-VSCC patients on both uni- and multivariate regression analyses. Patients with dVIN have a high risk of developing both primary and recurring VSCC. Early recognition, long-term follow up, and compliant ultrapotent topical corticosteroid treatment are recommended.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
Références
Thuijs NB, van Beurden M, Bruggink AH, Steenbergen RDM, Berkhof J, Bleeker MCG. Vulvar intraepithelial neoplasia: incidence and long-term risk of vulvar squamous cell carcinoma. Int J Cancer. 2021;148:90-98.
Mancini S, Bucchi L, Baldacchini F, et al. Incidence trends of vulvar squamous cell carcinoma in Italy from 1990 to 2015. Gynecol Oncol. 2020;157:656-663.
Faber MT, Sand FL, Albieri V, Norrild B, Kjaer SK, Verdoodt F. Prevalence and type distribution of human papillomavirus in squamous cell carcinoma and intraepithelial neoplasia of the vulva. Int J Cancer. 2017;141:1161-1169.
Preti M, Rotondo JC, Holzinger D, et al. Role of human papillomavirus infection in the etiology of vulvar cancer in Italian women. Infect Agent Cancer. 2020;15:20.
WHO Classification of Tumours Editorial Board. Female Genital Tumours: WHO Classification of Tumours. 5th ed. Female Genital Tumours: Medicine Series; 2020:257-264. https://tumourclassification.iarc.who.int/chapters/34
Borella F, Preti M, Bertero L, et al. Is there a place for immune checkpoint inhibitors in vulvar neoplasms? A state of the art review. Int J Mol Sci. 2021;22:1-23.
Rasmussen CL, Thomsen LT, Baandrup L, et al. Changes in HPV prevalence in Danish women with vulvar cancer during 28 years - a nationwide study of >1300 cancer cases. Gynecol Oncol. 2022;166:589-595.
Preti M, Borella F, Ferretti S, et al. Genital and extragenital oncological risk in women with vulvar lichen sclerosus: a multi-center Italian study. Maturitas. 2023;175:107767.
Halonen P, Jakobsson M, Heikinheimo O, Riska A, Gissler M, Pukkala E. Lichen sclerosus and risk of cancer. Int J Cancer. 2017;140:1998-2002.
Ueda Y, Enomoto T, Kimura T, Yoshino K, Fujita M, Kimura T. Two distinct pathways to development of squamous cell carcinoma of the vulva. J Skin Cancer. 2011;2011:1-7.
Bigby SM, Eva LJ, Fong KL, Jones RW. The natural history of vulvar intraepithelial neoplasia, differentiated type: evidence for progression and diagnostic challenges. Int J Gynecol Pathol. 2016;35:574-584.
Bornstein J, Bogliatto F, Haefner HK, et al. The 2015 International Society for the Study of vulvovaginal disease (ISSVD) terminology of vulvar squamous intraepithelial lesions. Obstet Gynecol. 2016;127:264-268.
Abell MR, Gosling JRG. Intraepithelial and infiltrative carcinoma of vulva: Bowen's type. Cancer. 1961;14:318-329.
Hart WR. Cutaneous vulvar diseases. Contemp Ob Gyn. 1977;9:45-50.
Wilkinson EJ, Kneale B, Lynch PJ. Report of the ISSVD terminology committee. J Reprod Med Obstet Gynecol. 1986;31:973-974.
Heller DS, Day T, Allbritton JI, et al. Diagnostic criteria for differentiated vulvar intraepithelial neoplasia and vulvar aberrant maturation. J Low Genit Tract Dis. 2021;25:57-70.
Preti M, Joura E, Vieira-Baptista P, et al. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of vulvovaginal disease (ISSVD), the European College for the Study of Vulval disease (ECSVD) and the European Federation for Colposcopy (EFC) consensus statem. Int J Gynecol Cancer. 2022;32:830-845.
Lee A, Bradford J, Fischer G. Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women. JAMA Dermatol. 2015;151:1061-1067.
Kesić V, Vieira-Baptista P, Stockdale CK. Early diagnostics of vulvar intraepithelial neoplasia. Cancers (Basel). 2022;14:1822.
Wilkinson EJ. Superficially invasive carcinoma of the vulva. Clin Obstet Gynecol. 1991;34:651-661.
American Joint Committee on Cancer. Vulva. AJCC Cancer Staging Manual. 8th ed. American Joint Committee on Cancer; 2017:747-756.
Swarts DRA, Voorham QJM, van Splunter AP, et al. Molecular heterogeneity in human papillomavirus-dependent and -independent vulvar carcinogenesis. Cancer Med. 2018;7:4542-4553.
Voss FO, Thuijs NB, Vermeulen RFM, Wilthagen EA, van Beurden M, Bleeker MCG. The vulvar cancer risk in differentiated vulvar intraepithelial neoplasia: a systematic review. Cancers (Basel). 2021;13:6170.
Yang B, Hart WR. Vulvar intraepithelial neoplasia of the simplex (differentiated) type: a clinicopathologic study including analysis of HPV and p53 expression. Am J Surg Pathol. 2000;24:429-441.
van de Nieuwenhof HP, Massuger LFAG, van der Avoort IAM, et al. Vulvar squamous cell carcinoma development after diagnosis of VIN increases with age. Eur J Cancer. 2009;45:851-856.
Regauer S, Eberz B, Reich O. Human papillomavirus-induced squamous intraepithelial lesions in vulvar lichen planus. J Low Genit Tract Dis. 2016;20:360-364.
McAlpine JN, Kim SY, Akbari A, et al. HPV-independent differentiated vulvar intraepithelial neoplasia (dVIN) is associated with an aggressive clinical course. Int J Gynecol Pathol. 2017;36:507-516.
Thuijs NB, van Beurden M, Duin S, et al. High-grade vulvar intraepithelial neoplasia: comprehensive characterization and long-term vulvar carcinoma risk. Histopathology. 2023;301-14:301-314.
Eva LJ, Ganesan R, Chan KK, Honest H, Luesley DM. Differentiated-type vulval intraepithelial neoplasia has a high-risk association with vulval squamous cell carcinoma. Int J Gynecol Cancer. 2009;19:741-744.
te Grootenhuis NC, Pouwer AW, de Bock GH, et al. Margin status revisited in vulvar squamous cell carcinoma. Gynecol Oncol. 2019;154:266-275.
Huang J, Chan SC, Fung YC, et al. Global incidence, risk factors and trends of vulvar cancer: a country-based analysis of cancer registries. Int J Cancer. 2023;153:1734-1745.
Madeleine MM, Daling JR, Schwartz SM, et al. Cofactors with human papillomavirus in a population-based study of vulvar cancer. JNCI J Natl Cancer Inst. 1997;89:1516-1523.
Voss FO, Thuijs NB, Duin S, et al. Clinical validation of methylation biomarkers for optimal detection of high-grade vulvar intraepithelial neoplasia. Int J Cancer. 2023;153:783-791.