The impact of p16ink4a positivity in invasive vulvar cancer on disease-free and disease-specific survival, a retrospective study

Arch Gynecol Obstet. 2020 Mar;301(3):753-759. doi: 10.1007/s00404-020-05431-7. Epub 2020 Jan 22.


Purpose: To evaluate HPV and p16ink4a status as prognostic factors in patients with invasive vulvar cancer.

Methods: Retrospective analysis of disease-free (DFS) and disease-specific survival (DSS) of patients with invasive vulvar cancer at a single tertiary care center. Histology, HPV and p16ink4a status were evaluated in the context of a global multicenter trial. Logistic regression models were performed to identify the impact of p16ink4a positivity.

Results: 135 patients were included in the analysis. 32 (23.7%) showed a p16ink4a expression of over 25%. Disease-free and disease-specific survival was longer in p16ink4a positive patients (23 vs. 10 months, p = 0.004, respectively, 29 vs. 21 months, p = 0.016). In multivariate analysis, p16ink4a positivity was an independent parameter for DFS (p = 0.025, HR: 2.120 (1.100-4.085)), but not for DSS (p = 0.926, HR: 1.029 (0.558-1.901), in contrast to age and tumor stage.

Conclusions: Age and tumor stage negatively affect survival. However, disease-free survival is significantly longer in patients with p16ink4a positive invasive vulvar cancer.

Keywords: HPV; Prognosis; Survival; Vulvar cancer; p16ink4a.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers, Tumor / metabolism*
  • Cyclin-Dependent Kinase Inhibitor p16 / metabolism*
  • Disease-Free Survival
  • Female
  • Humans
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Survival Analysis
  • Vulvar Neoplasms / genetics*
  • Vulvar Neoplasms / mortality
  • Vulvar Neoplasms / pathology


  • Biomarkers, Tumor
  • Cyclin-Dependent Kinase Inhibitor p16