EGFR expression in vulvar cancer: clinical implications and tumor heterogeneity.

Abstract

Epidermal growth factor receptor (EGFR) protein expression was assessed by immunohistochemistry (IHC) in 150 cases of invasive vulvar squamous cell carcinoma. In addition, gene copy number status by fluorescence in situ hybridization was performed in a smaller set of samples. Results were correlated with patient's clinical data and prognostic factors. EGFR overexpression (2+ and 3+) was observed on the membrane in 24.66% and 21.33% of all cases, respectively. Higher EGFR expression was associated with depth of invasion (P = .0409) and disease recurrence (P = .0401). Cytoplasm staining was found in 21.33% of the cases and was associated with absence of nodal metastasis (P = .0061) and better survival (P = .0199). Intratumor heterogeneity of EGFR IHC staining was frequently observed (55.33%) and was associated with the presence of nodal metastasis (P = .0207) and tumor invasion (P = .0161). Worse survival outcomes have been demonstrated in tumors with EGFR heterogeneity (P = .0434). EGFR gene status evaluated by fluorescence in situ hybridization did not correlate with protein expression evaluated by IHC. In conclusion, EGFR cytoplasm staining has no link with poorer outcome; still, this pattern of staining is even more related to better prognosis. EGFR heterogeneity of staining correlated with more aggressive tumors, and presented to be an important marker of poor prognosis in vulvar squamous cell carcinoma. The usage of small biopsies or even tissue microarrays for vulvar cancer evaluation should be carefully reconsidered for the assessment of EGFR as the results may be misleading. Protein overexpression may be independent on gene amplification, showing that other molecular mechanisms than copy number variation may regulate protein expression of EGFR in vulvar cancer.

• Authors: Beatriz de Melo Maia, Adriana Mazega Fontes, André Mourão Lavorato-Rocha, Iara Sant'Ana Rodrigues, Louise de Brot, Glauco Baiocchi, Monica Maria Stiepcich, Fernando Augusto Soares, Rafael Malagoli Rocha
• Journal: Human pathology (Hum Pathol) Vol. 45 Issue 5 Pg. 917-25 (May 2014) ISSN: 1532-8392 [Electronic] United States
• PMID: 24746196 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• ErbB Receptors

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell (genetics, metabolism, pathology)
• DNA Copy Number Variations
• ErbB Receptors (biosynthesis, genetics)
• Female
• Gene Dosage
• Humans
• Immunohistochemistry
• In Situ Hybridization, Fluorescence
• Middle Aged
• Prognosis
• Vulvar Neoplasms (genetics, metabolism, pathology)