Immunological and Clinical Impact of Cancer Stem Cells in Vulvar Cancer: Role of CD133/CD24/ABCG2-Expressing Cells

Abstract

Abstract. Background: Cancer stem cells (CSCs) are tumour-initiating cells with self-renewal properties and chemo/radio-resistance. Regulatory T-cells (Tregs) influenceVulvar cancer is an uncommon gynaecological malignancy; approximately 4,850 new cases of vulvar cancer and 1,030 deaths from this disease were projected for the United States in 2014 (1). Most patients are elderly, with a peak of incidence in the eighth decade; nearly 30% are diagnosed at international Federation of Gynaecology and Obstetrics (FIGO) stage III or IV with a 5-year overall survival of 43% and 13%, respectively (2). Although representing a rare disease of elderly women with a current incidence of 2-3 per 100,000 women and a median age of 65-70 years old, vulvar cancer has shown an increasing incidence with concurrently decreasing median age of 55-60 years at onset over the past few decades (1, 3).The standard treatment of vulvar cancer includes radical surgery and adjuvant radiotherapy in selected cases. Considering the median age of these patients, clinical and pathological prognostic factors are constantly being explored in order to minimize unnecessary treatments. Furthermore, new molecules are being investigated to propose target therapies and increase patient survival.In the past decade, cancer stem cells (CSCs) have been identified as tumour-initiating cells. This subpopulation is resistant to cancer therapy such as chemo-and radiotherapies and successful treatments are dependent on the elimination of these cells (4). In addition, several reports highlight the interaction between CSCs and the immune system. 5109

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