Patterns of invasion and stromal response are understudied in vulvar squamous cell carcinoma. The aim of this study was to explore whether histologic features such as an infiltrative pattern of invasion and fibromyxoid stromal response (FMX-SR) are meaningful prognostic factors. We reviewed 143 vulvar squamous cell carcinoma resections and correlated patterns of invasion and stromal response with patient age, ethnicity, depth of invasion, tumor size, perineural invasion (S100/AE1/3 stain), lymph node involvement (LNI), extranodal extension, margin status, pathologic stage, and recurrence. Univariate analyses of continuous variables were performed using t tests, whereas Pearson χ tests were used for categorical variables. Logistic regression analyses examined the relationship between histopathologic characteristics and clinical outcomes. There was a statistically significant association between infiltrative tumors and an FMX-SR in comparison with noninfiltrative tumors (P<0.001). Tumors with FMX-SR were significantly more deeply invasive (P=0.0025) and more likely to have LNI (P=0.0364), extranodal extension (P=0.0227), and perineural invasion (P=0.0011) compared with tumors without FMX-SR. For cases with negative surgical margins, the association between tumors with FMX-SR and LNI was significantly strengthened (odds ratio=4.73, P=0.0042), even after adjustments for age, race, and depth of invasion (odds ratio=4.34, P=0.0154). The presence of both FMX-SR and an infiltrative pattern of invasion in tumors with negative margins was significantly associated with LNI (P=0.0235) and recurrence (P=0.0124). These results suggest that interactions between nerve, tumor, and stromal cells play a role in tumor progression and represent additional prognostic factors that help stratify those patients at highest risk for LNI, extranodal extension, and recurrence.
外阴鳞状细胞癌的浸润方式和间质反应，没有足够多的研究。本文旨在揭示其组织学特征如浸润方式及纤维黏液样间质反应（FMX—SR）是否是有意义的预后因素。我们复习了143例外阴鳞状细胞癌切除标本，寻找其浸润方式和间质反应与病人年龄、种族、浸润深度、 肿瘤大小、神经周围浸润（S100和AE1/3 染色）、淋巴结累及（LNI）、结外侵犯、切缘情况、病理分期及肿瘤复发之间的相关性。连续变量的单因素分析用t检验，分类变量的关联性分析用χ2检验，组织病理学特征与临床结果之间的关系用logistic回归分析检测。与非浸润性肿瘤相比，浸润性肿瘤和FMX—SR之间存在统计学意义上的关联关系(P<0.001)。与没有FMX—SR的肿瘤相比，存在FMX-SR的肿瘤，浸润得更深(P=0.0025)，更可能有LNI(P=0.0364)、结外侵犯(P=0.0227)和神经周围浸润(P=0.0011)。切缘阴性的病例，有FMX—SR的肿瘤与LNI之间的关联性显著增强(OR=4.73, P=0.0042)，即使将年龄、种族及浸润深度因素调整后亦如此（OR=4.34, P=0.0154）。切缘阴性的肿瘤中，存在FMX—SR同时又有浸润性生长方式时，FMX—SR与LNI(P=0.0235)之间以及与肿瘤复发(P=0.0124）之间皆有显著关联性。 这些结果提示神经、肿瘤及间质细胞之间的相互作用在肿瘤进展中发挥作用，代表着肿瘤的预后因素，有助于区分出发生LNI、结外侵犯及复发风险最高的患者。