Molekulare Klassifikation des Vulvakarzinoms

The molecular subtyping of vulvar squamous cell carcinoma (VSCC) replaces the previous classification according to purely histopathological criteria. The different molecular subtypes are based on morphomolecular examination of tumor tissue in pathology using p16 and p53 immunohistochemistry. Molecular subtyping of VSCC allows for a more individualized prognosis, can predict response to chemoradiotherapy, and may enable modification of surgical radicality and oncological aftercare. Histopathological p16 and p53 expression analyses are accepted as surrogate markers for human papillomavirus (HPV) high-risk infection and TP53 mutation by the World Health Organization (WHO). The most common molecular subtype is caused by TP53 mutation with aberrant p53 immunoexpression. It occurs in older women and is associated with a poorer prognosis, poorer response to chemoradiotherapy, and may benefit from more radical surgery. The second most common subtype caused by high-risk HPV infection is associated with better prognosis, occurrence in younger patients, and higher sensitivity to chemoradiation; it may be treated with reduced surgical radicality. Squamous cell carcinoma with neither high-risk HPV infection nor TP53 mutation represents the rarest molecular subtype with intermediate prognosis. This subtype may be caused by mutations in NOTCH1, PIK3CA, and/or RAS genes.