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Eur J Cancer. 2013 Nov;49(16):3450-61. doi: 10.1016/j.ejca.2013.06.033. Epub 2013 Jul 22.

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

Collaborators (183)

Perrotta M, Jaen A, Garland SM, Tabrizi SN, Wain GV, Kennedy CJ, Chiew YE, Sharma R, Joura EA, Stani J, Horvat R, Nessa A, Nahar Rahman AJ, Kamal M, Ahmed F, Viarheichyk H, Valeriy S, Searhei A, Iljazovic E, Maldonado P, Almeida GL, Val I, Fonseca R, Lima RJ, Mannarino M, Furtado Y, Prado R, Molina C, Muños R, Rodriguez X, Guerrero M, Leiva V, Olave E, Ramis C, Toro V, Murillo R, Hernández Suárez GA, Pinzón CE, Muñoz N, Mandys V, Laco J, Tinoco L, Clavel C, Birembaut P, Dalstein V, Bergeron C, Tommasino M, Hampl M, Baldus, Petry KU, Pawlita M, Halec G, Holzinger D, Agorastos T, Lombardi LE, Kestler E, Salic O, Marroquin S, Argueta V, Guerra W, Morales H, Ferrera A, Henríquez O, Portillo S, Bhatla N, Bornstein J, Livoff A, Cohen HI, Mariani L, Vocaturo A, Benevolo M, Marandino F, Rollo F, Shin HR, Oh JK, Kang SG, Kim DC, Al-Jassar W, Al-Safi R, Seoud M, Kamate B, Ndiaye C, Alvarado-Cabrero I, López-Revilla R, Magaña-León C, Oros C, Carrilho C, Bigby SM, Eva LJ, Jones RW, Banjo AA, Abdulkareem FB, Daramola AO, Anunobi CC, Anorlu RU, Malami S, Umar AB, Kasamatsu E, Cubilla AL, Perrota F, Llave CL, Toral JA, Domingo EJ, Germar MJ, Thaddeus J, Luna P, Fernandez AM, Castro CZ, Balacuit R, Nowakowski AM, Jach R, Orlowska-Heitzman J, Kabzinska-Turek M, Przybylska P, kula-Prykan M, Cruz E, Gentil F, Félix A, Ndiaye C, Ndiaye Ba N, Mendes V, Alejo M, Lloveras B, Alemany L, Bosch F, Bravo I, Camón V, Castellsagué X, Clavero O, de Sanjosé S, Espuña I, Esteban A, Godínez JM, Florencia Y, Klaustermeier J, Muñoz N, Patón N, Quirós B, Saunier M, Rajo C, Tous S, Vergara M, Vidal A, Condom E, Ordi J, Velasco J, Pérez C, Cheng-Yang C, Chu TY, Huang KF, Wen-Fang C, Ho CM, Quint W, Molijn AC, Geraets DT, Guimera N, Meijer CJ, Usubutun A, Kitchener H, Wilson G, Cross P, Sica AR, Caserta B, Cedeira M, Mazal D, Rodríguez G, Cozen W, Goodman MT, Hernández BY, Lynch CF, Olson DB, Selk FR, Barriola VG, de Gómez MN, Figueredo A, Navarro J, Meijer CJ, Tommasino M, Pawlita M, Ordi J, Quint W, Alejo M, Muñoz N.

Author information

Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address:



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.


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 (LiPA25) (version 1). IVC cases were tested for p16(INK4a) by immunohistochemistry (CINtec histology kit, ROCHE). An IVC was considered HPV driven if both HPV-DNA and p16(INK4a) 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).


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 p16(INK4a) 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).


Combined data from HPV-DNA and p16(INK4a) 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.


Papillomavirus; Vulva; p16(INK4a)

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