MEASUREMENT OF EPITHELIAL AND STROMAL CHANGES IN VULVAR CARCINOMA - ACLINICAL, BIOCHEMICAL AND IMMUNOHISTOCHEMICAL STUDY

We evaluated the clinical usefulness of the squamous cell carcinoma an tigen (SCC) and CA 125, serum markers of epithelial cancer cells, in c omparison with the serum concentration and tissue distribution of the aminoterminal propeptide of type III procollagen (PIIINP), a marker of connective tissue metabolism, in 31 patients with vulvar carcinoma. T he SCC concentration was increased in 42%, that of CA 125 in 14% and t hat of PIIINP in 36% of the cases. The combination of SCC and PIIINP i ncreased the detection rate to 57% and that of all three to 64%. None of the tumor markers correlated with the clinical stage of the disease . The initial values of the serum markers did not discriminate between different patterns of the clinical behavior of the disease. Six patie nts were followed with serial determinations of the markers. In each c ase at least one of the markers correlated with the clinical course of the disease. SCC did so in 5 cases, PIIINP in 3 cases and CA 125 in 2 cases. The mean concentrations of SCC and CA 125, but not that of PII INP, were significantly lower during the periods of response to therap y than during the nonresponsive periods. Immunohistochemistry of PIIIN P showed vulvar carcinoma to be associated with a distinct collagenous stroma. In the junctional area of the stroma around the malignant epi thelium, the PIIINP positive fibers grew more sparse and irregular wit h decreasing differentiation of the tumor. The present data suggest th at SCC, CA 125 and PIIINP are useful, especially SCC, in monitoring th e clinical behaviour of the advanced vulvar cancer, less so in predict ing its prognosis.