IDENTIFICAÇÃO DOS ASPECTOS CLÍNICOS E EPIDEMIOLÓGICOS E PREVALÊNCIA DO HPV EM AMOSTRAS DE PACIENTES COM CÂNCER DE VULVA DO ESTADO DO MARANHÃO

Abstract

Vulvar cancer (VC), although rare, represents a public health challenge, particularly in regions marked by pronounced socioeconomic inequalities and limited access to early diagnosis, such as some areas of Brazil, especially the state of Maranhão. According to the World Health Organization (WHO), VC can arise through two etiological pathways: an HPV-dependent pathway and an HPV-independent pathway. However, the lack of local studies addressing the epidemiological, clinical, and molecular aspects of this neoplasm highlights a gap in the understanding of the disease in the state. The aim of this study was to investigate the association between HPV infection, the protein expression profile (p16INK4a , p53, and Ki-67), and the clinical, histopathological, and epidemiological characteristics of patients diagnosed with VC between 2013 and 2023. This is an observational, retrospective, hospital-based study involving the analysis of archived samples and clinical-epidemiological data. Clinical, epidemiological, and histopathological variables were analyzed, along with the assessment of protein expression by immunohistochemistry (IHC) and molecular detection of HPV by polymerase chain reaction (PCR). Associations were evaluated using bivariate statistical tests. A total of 76 cases were analyzed, with a predominance of patients over 60 years of age (mean age: 64.7 years), low educational attainment, mostly from northern Maranhão, and moderately differentiated tumors (G2) in 60.5% of cases. IHC showed positive expression of p16^INK4a in 64.3%, p53 expression with a wild-type pattern in 75% and an aberrant pattern in 25%, and high Ki-67 proliferation (score ≥50%) in 50% of cases. A significant association was observed between positive p16INK4a and wild-type p53 (p=0.002). Tumors with high Ki-67 levels showed a higher frequency of angiolymphatic invasion (p =0.035). There was a high frequency of HPV viral DNA, with 75% positivity in amplified samples, and a significant association with p16INK4a (p=0.022). These results demonstrate that the HPV-dependent pathway may play a substantial role in the tumor profile of patients from Maranhão. This is the first study in Maranhão to integrate epidemiological, histopathological, molecular, immunohistochemical, and survival data in vulvar cancer. The analysis of p16INK4a , p53, and HPV showed potential to distinguish HPV-dependent and HPV-independent tumors, improving etiological classification. Given the high prevalence of HPV-positive neoplasms in the population of Maranhão, such as penile and cervical cancers, it is essential to expand studies with larger samples to further elucidate the underlying mechanisms.