Prognostic indicators and survival rates in vulvar cancer: insights from a retrospective study

This study aimed to ascertain prognostic indicators impacting progression-free survival (PFS) and overall survival (OS) in patients diagnosed with vulvar cancer. The secondary aim was to determine a quantifiable measure of PFS and OS for these patients. A comprehensive retrospective review was conducted of the medical records of vulvar cancer patients treated at Siriraj Hospital from 2006 to 2020. Patient characteristics, surgical outcomes, pathological features and immunohistochemical results for p16, p53 and PD-L1 were analysed for their potential as prognostic indicators for survival outcomes. In the sample of 104 vulvar cancer patients, four factors were significantly associated with a worsening PFS. They were coexisting vulvar lesions such as lichen sclerosus and extramammary Paget’s disease (<i>p</i> = .008); lymphovascular space invasion (LVSI; <i>p</i> = .011); pelvic or paraaortic lymph node metastases (<i>p</i> = .042); and positive p53 status (<i>p</i> = .046). Additionally, a tumour size exceeding 4 cm in diameter was significantly linked with decreased OS (<i>p</i> = .001). The median PFS and OS were calculated as 26.3 and 44.7 months, respectively. Significantly improved PFS and OS were noted in patients with a positive p16 or a negative p53 immunohistochemical profile. The calculated hazard ratios for these two subsets were 3.032 (95% CI = 1.419–6.480; <i>p</i> = .004) and 2.421 (95% CI = 1.120–5.232; <i>p</i> = .025), respectively. Factors leading to unfavourable PFS are coexisting vulvar lesions, positive LVSI status, pelvic or paraaortic lymph node metastases, and positive p53 status. Regarding OS, a tumour diameter exceeding 4 cm significantly correlates with poorer outcomes. A retrospective study conducted at Siriraj Hospital in Thailand analysed 104 vulvar cancer patients treated between 2006 and 2020. The mean patient age was 63 years, with 72.1% being postmenopause. Squamous cell carcinoma (SCC) was the predominant histological type, observed in 78.9% of cases. Immunohistochemical analysis revealed positive expression of p16 and p53 in 33.7% of tumours each, while PD-L1 positivity was found in 19.8% of cases. The study identified several factors associated with poorer progression-free survival (PFS) and overall survival (OS). Multivariate analysis indicated that coexisting lesions such as Paget’s disease and lichen sclerosus, positive lymphovascular space invasion (LVSI), pelvic or para-aortic lymph node involvement, and positive p53 expression were significantly linked to reduced PFS. Additionally, a tumour size greater than 4 cm was associated with decreased OS. These findings align with previous research highlighting the prognostic significance of p16 and p53 expression in vulvar cancer. The role of PD-L1 expression in vulvar cancer prognosis remains inconclusive, with some studies suggesting a potential association with survival outcomes, while others do not. Strengths of this study include its comprehensive analysis of clinical, pathological and immunohistochemical factors within a single cohort. However, limitations such as its retrospective design, relatively small sample size and potential selection bias may affect the generalisability of the results.本研究旨在明确影响外阴癌患者无进展生存期（progression-free survival, PFS）与总生存期（overall survival, OS）的预后指标，次要目标为确定此类患者PFS与OS的可量化评估标准。本研究对2006年至2020年在诗里拉吉医院（Siriraj Hospital）接受治疗的外阴癌患者的病历资料开展全面回顾性分析，对患者的人口学特征、手术结局、病理特征，以及p16、p53与PD-L1的免疫组化结果进行评估，以明确其作为生存结局预后指标的潜力。 本研究共纳入104例外阴癌患者，其中4项因素与较差的PFS显著相关：合并外阴病变（如硬化性苔藓及乳腺外佩吉特病，p=0.008）、淋巴血管间隙浸润（lymphovascular space invasion, LVSI，p=0.011）、盆腔或腹主动脉旁淋巴结转移（p=0.042），以及p53阳性状态（p=0.046）。此外，肿瘤直径超过4cm与OS降低显著相关（p=0.001）。本研究计算得出的中位PFS与中位OS分别为26.3个月与44.7个月。p16阳性或p53阴性免疫组化表型的患者，其PFS与OS均显著更优，该两个亚组的风险比分别为3.032（95%置信区间[CI]：1.419~6.480；p=0.004）与2.421（95%CI：1.120~5.232；p=0.025）。 与较差PFS相关的因素包括合并外阴病变、LVSI阳性、盆腔或腹主动脉旁淋巴结转移，以及p53阳性状态。就OS而言，肿瘤直径超过4cm与不良结局显著相关。 本项在泰国诗里拉吉医院开展的回顾性研究，分析了2006年至2020年间收治的104例外阴癌患者。患者的平均年龄为63岁，其中72.1%为绝经后女性。鳞状细胞癌（squamous cell carcinoma, SCC）为主要组织学类型，占所有病例的78.9%。免疫组化分析显示，33.7%的肿瘤呈p16阳性表达，33.7%的肿瘤呈p53阳性表达，而PD-L1阳性表达的病例占比为19.8%。 本研究明确了多项与较差PFS及OS相关的因素。多因素分析结果显示，合并佩吉特病、硬化性苔藓等外阴病变，LVSI阳性，盆腔或腹主动脉旁淋巴结受累，以及p53阳性表达，均与PFS降低显著相关。此外，肿瘤直径大于4cm与OS降低相关。本研究结果与此前针对外阴癌中p16与p53表达预后价值的研究结论一致。PD-L1表达在外阴癌预后中的作用仍未明确，部分研究提示其与生存结局存在潜在关联，而另一些研究则未发现此类关联。 本研究的优势在于对单一队列的临床、病理及免疫组化因素进行了全面分析。但本研究也存在局限性：其为回顾性研究设计，样本量相对较小，且存在潜在的选择偏倚，这些因素可能会影响研究结果的外推性。