Worldwide human papillomavirus genotype attribution in over 2000 cases of intraepithelial and invasive lesions of the vulva

Silvia De Sanjosé, Laia Alemany, Jaume Ordi, Sara Tous, Maria Alejo, Susan M. Bigby, Elmar Armin Joura, Paula Maldonado, Jan Laco, Ignacio G. Bravo, August Vidal, Núria Guimerà, Paul Cross, Gerard V. Wain, Karl Ulrich Petry, Luciano Mariani, Christine Bergeron, Václav Mandys, Adela Rosa Sica, Ana FélixAlp Usubutun, Muhieddine Seoud, Gustavo Hernández-Suárez, Andrzej Marcin Nowakowski, Godfrey Wilson, Veronique Dalstein, Monika Hampl, Elena Sachiko Kasamatsu, Luis Estuardo Lombardi, Leopoldo Tinoco, Isabel Alvarado-Cabrero, Myriam Perrotta, Neerja Bhatla, Theodoros Agorastos, Charles F. Lynch, Marc T. Goodman, Hai Rim Shin, Halina Viarheichyk, Robert Jach, M. O L Eugenia Cruz, Julio Velasco, Carla Molina, Jacob Bornstein, Annabelle Ferrera, Efren Javier Domingo, Cheng Yang Chou, Adekunbiola F. Banjo, Xavier Castellsagué, Michael Pawlita, Belén Lloveras, Wim G V Quint, Nubia Muñoz, F. Xavier Bosch

Research output: Contribution to journalArticlepeer-review


Background Human papillomavirus (HPV) contribution in vulvar intraepithelial lesions (VIN) and invasive vulvar cancer (IVC) is not clearly established. This study provides novel data on HPV markers in a large series of VIN and IVC lesions. Methods Histologically confirmed VIN and IVC from 39 countries were assembled at the Catalan Institute of Oncology (ICO). HPV-DNA detection was done by polymerase chain reaction using SPF-10 broad-spectrum primers and genotyping by reverse hybridisation line probe assay (LiPA 25) (version 1). IVC cases were tested for p16INK4a by immunohistochemistry (CINtec histology kit, ROCHE). An IVC was considered HPV driven if both HPV-DNA and p16INK4a overexpression were observed simultaneously. Data analyses included algorithms allocating multiple infections to calculate type-specific contribution and logistic regression models to estimate adjusted prevalence (AP) and its 95% confidence intervals (CI). Results Of 2296 cases, 587 were VIN and 1709 IVC. HPV-DNA was detected in 86.7% and 28.6% of the cases respectively. Amongst IVC cases, 25.1% were both HPV-DNA and p16INK4a positive. IVC cases were largely keratinising squamous cell carcinoma (KSCC) (N = 1234). Overall prevalence of HPV related IVC cases was highest in younger women for any histological subtype. SCC with warty or basaloid features (SCC-WB) (N = 326) were more likely to be HPV and p16 INK4a positive (AP = 69.5%, CI = 63.6-74.8) versus KSCC (AP = 11.5%, CI = 9.7-13.5). HPV 16 was the commonest type (72.5%) followed by HPV 33 (6.5%) and HPV 18 (4.6%). Enrichment from VIN to IVC was significantly high for HPV 45 (8.5-fold). Conclusion Combined data from HPV-DNA and p16INK4a testing are likely to represent a closer estimate of the real fraction of IVC induced by HPV. Our results indicate that HPV contribution in invasive vulvar cancer has probably been overestimated. HPV 16 remains the major player worldwide.

Original languageEnglish
Pages (from-to)3450-3461
Number of pages12
JournalEuropean Journal of Cancer
Issue number16
Publication statusPublished - Nov 2013


  • p16
  • Papillomavirus
  • Vulva

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


Dive into the research topics of 'Worldwide human papillomavirus genotype attribution in over 2000 cases of intraepithelial and invasive lesions of the vulva'. Together they form a unique fingerprint.

Cite this