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Projects "PI20/00368; Caracterizacion genomica de los carcinomas de vulva independientes de virus del papiloma humano y de sus precursores" and "PI23/00494; Perfiles de expresion genica de los tres subtipos principales de los carcinomas escamosos de vulva," funded by Instituto de Salud Carlos III and cofunded by the European Union (ERDF) "A way to make Europe." ISGlobal receives support from the Spanish Ministry of Science and Innovation through the "Centro de Excelencia Severo Ochoa 2019-2023" Program (CEX2018-000806-S) and support from the Generalitat de Catalunya through the CERCA Program. The entire study was funded by the Spanish Instituto de Salud Carlos III (FIS, PI20/368 and PI23/494; NR and JO).

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Whole-Exome Sequencing of Vulvar Squamous Cell Carcinomas Reveals an Impaired Prognosis in Patients With TP53 Mutations and Concurrent CCND1 Gains

Publicated to:Modern Pathology. 37 (10): 100574- - 2024-08-17 37(10), DOI: 10.1016/j.modpat.2024.100574

Authors: Ordi, Oriol; Saco, Adela; Penuelas, Nuria; Blanco-Irazuegui, Odei; del Pino, Marta; Carreras-Dieguez, Nuria; Marimon, Lorena; Rodrigo-Calvo, Maria Teresa; Morato, Alba; Sisuashvili, Lia; Bustamante, Mariona; Cruells, Adria; Darecka, Katarzyna; Vega, Naiara; Alos, Silvia; Trias, Isabel; Fuste, Pere; Parra, Genis; Gut, Marta; Munmany, Meritxell; Jares, Pedro; Rakislova, Natalia

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Abstract

Very little information is available on the mutational landscape of vulvar squamous cell carcinoma (VSCC), a disease that mainly affects older women. Studies focusing on the mutational patterns of the currently recognized etiopathogenic types of this tumor (human papillomavirus [HPV]-associated [HPV-A], HPV-independent [HPV-I] with TP53 mutation [HPV-I/TP53mut], and HPV-I with wild-type TP53 [HPV-I/TP53wt]) are particularly rare, and there is almost no information on the prognostic implications of these abnormalities.Whole-exome DNA sequencing of 60 VSCC and matched normal tissues from each patient was performed. HPV detection, immunohistochemistry (IHC) for p16, p53, and mismatch repair proteins were also performed. Ten tumors (16.7%) were classified as HPV-A, 37 (61.7%) as HPV-I/TP53mut, and 13 (21.6%) as HPV-I/TP53wt. TP53 was the most frequently mutated gene (66.7%), followed by FAT1 (28.3%), CDKN2A (25.0%), RNF213 (23.3%), NFE2L2 (20%) and PIK3CA (20%). All the 60 tumors (100%) were DNA mismatch repair proficient. Seventeen tumors (28.3%) showed CCND1 gain. Bivariate analysis, adjusted for International Federation of Gynecology and Obstetrics stage, revealed that TP53 mutation, CCND1 gain, and the combination of the 2 alterations were strongly associated with impaired recurrence-free survival (hazard ratio, 4.4; P < .001) and disease-specific survival (hazard ratio, 6.1; P = .002). Similar results were obtained when p53 IHC status was used instead of TP53 status and when considering only HPV-I VSCC. However, in the latter category, p53 IHC maintained its prognostic impact only in combination with CCND1 gains. All tumors carried at least one potentially actionable genomic alteration. In conclusion, VSCCs with CCND1 gain represent a prognostically adverse category among HPV-I/TP53mut tumors. All patients with VSCCs are potential candidates for targeted therapy. (c) 2024 THE AUTHORS. Published by Elsevier Inc. on behalf of the United States & Canadian Academy of Pathology. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).

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