- AJSP 单队列研究：172 例外阴鳞癌（1990–2022），分 HPV 相关、HPV 非依赖/p53 异常、HPV 非依赖/p53 野生型三组，评估肿瘤出芽活性（TBA）与肿瘤–间质比（TSR）。
- 阈值：TBA ≥20/10 HPF 与较短无复发生存相关（全队列 P=0.002；HPV 非依赖/p53 异常组 P=0.003）。
- 在 HPV 非依赖/p53 异常组校正 LVI 及 T、N 后仍独立（P=0.012）；全队列校正后 TBA 也与疾病特异性生存和总生存相关。
- 摘要未报告 TSR 的预后结果。作者认为有待进一步验证。原文为订阅内容，本站仅收摘要。
收录范围：PubMed 摘要中英对照。原文为 Ovid/LWW 订阅内容（licenseInfoList 为空），本站未获全文与图表。
摘要
外阴鳞状细胞癌（vSCC）的结局取决于人乳头瘤病毒（HPV）与 p53 状态。鉴于肿瘤出芽活性（TBA）和肿瘤–间质比（TSR）在其他癌中具有预后意义，我们评估了二者在 vSCC 中的意义。检索 1990–2022 年诊断的肿瘤，评估临床病理资料、TBA 与 TSR。队列共 172 例：HPV 相关 73 例（42.5%）、HPV 非依赖/p53 异常 74 例（43%）、HPV 非依赖/p53 野生型 25 例（14.5%）。患者中位年龄 69.5 岁（22–98 岁）。多数肿瘤分期为 pT1b（132 例，76.7%）。25 例（14.5%）有淋巴血管侵犯（LVI）；行淋巴结评估的病例中 24.6%（33/134）有淋巴结转移。TBA 中位数为 2（0–45）/1 个高倍视野（HPF）、4（0–198）/5 HPF、5（0–304）/10 HPF。TSR 中位数为 60%（10%–90%）。70 例（40.7%）患者出现复发（中位 14 个月，2–141 个月）。TBA ≥20/10 HPF 在全队列（P=0.002）及 HPV 非依赖/p53 异常 vSCC（P=0.003）中均与较短的无复发生存（RFS）相关。在 HPV 非依赖/p53 异常 vSCC 中，校正 LVI 及 pTNM 分期的 T、N 类别后该关联仍存在（P=0.012）；在全队列中校正肿瘤亚型及其他协变量后亦然（P=0.01）。校正肿瘤亚型、LVI 及 T、N 类别后，TBA 还与较短的疾病特异性生存（P=0.048）和总生存（P=0.009）相关。本研究提示，高 TBA 与 vSCC 较短的无复发生存相关，在 HPV 非依赖/p53 异常亚组中尤为明显；校正肿瘤亚型、LVI 及 T、N 类别后，高 TBA 亦与较短的疾病特异性生存和总生存相关。上述发现有待进一步验证。
- AJSP cohort of 172 vulvar SCCs (1990–2022) split into HPV-associated, HPV-independent/p53-abnormal and HPV-independent/p53-wild-type, assessing tumor budding activity (TBA) and tumor-stroma ratio (TSR).
- Cut-off: TBA ≥20/10 HPF associated with shorter RFS (whole cohort P=0.002; HPV-independent/p53-abnormal P=0.003).
- Independent after adjusting for LVI and T/N in the HPV-independent/p53-abnormal group (P=0.012); also linked to disease-specific and overall survival after adjustment.
- The abstract does not report prognostic results for TSR. Findings warrant validation. Subscription content — abstract only.
Scope: the PubMed abstract. The article is Ovid/LWW subscription content (empty licenseInfoList); the full text and figures were not obtained.
Abstract
Outcomes of vulvar squamous cell carcinoma (vSCC) are driven by human papillomavirus (HPV) and p53 status. As tumor budding activity (TBA) and tumor-stroma ratio (TSR) are prognostic in other carcinomas, we evaluated their significance in vSCCs. Tumors diagnosed from 1990 to 2022 were identified, and clinicopathologic data, TBA, and TSR were assessed. The cohort included 172 tumors: 73 (42.5%) HPV-associated, 74 (43%) HPV-independent/p53-abnormal, and 25 (14.5%) HPV-independent/p53-wild-type. Median patient age was 69.5 (22 to 98) years. Most tumors were staged as pT1b (132, 76.7%). Lymphovascular invasion (LVI) was present in 25 (14.5%), and lymph node metastases in 24.6% (33/134) of cases with nodal evaluation. The median TBA was 2 (0-45)/1 high-power field (HPF), 4 (0-198)/5 HPF, and 5 (0-304)/10 HPF. The median TSR was 60% (10% to 90%). Seventy (40.7%) patients experienced recurrences (median: 14 mo, 2-141). Increased TBA at ≥20/10 HPF was associated with shorter recurrence-free survival (RFS) in the entire cohort (P=0.002) and HPV-independent/p53-abnormal vSCCs (P=0.003). This association persisted in the HPV-independent/p53-abnormal vSCCs after adjusting for LVI, and T and N categories of pTNM stage (P=0.012), and in the entire cohort after adjusting for tumor subtype and other covariates (P=0.01). TBA was also associated with shorter disease-specific (P=0.048) and overall (P=0.009) survival after adjusting for tumor subtype, LVI, and T and N categories. Our study suggests that high TBA is associated with shorter recurrence-free survival in vSCC, particularly the HPV-independent/p53-abnormal subgroup, as well as with shorter disease-specific and overall survival after adjusting for tumor subtype, LVI, T and N categories. The findings warrant further validation.