ETD

• CD4/CD8 ratio
• immune infiltrate
• prognosis
• tumor microenvironment
• vulvar cancer
• vulvar squamous cell carcinoma

Vulvar squamous cell carcinoma is a relatively rare gynecologic malignancy characterized by a high rate of local recurrence, even at early stages, and by limited prognostic biomarkers beyond traditional clinicopathological factors. Increasing evidence suggests that the tumor immune microenvironment plays a crucial role in modulating disease progression and clinical outcomes. In particular, the prognostic significance of tumor-infiltrating lymphocytes in vulvar cancer remains controversial and incompletely defined.
The aim of this retrospective study was to investigate the prognostic value of the CD4⁺/CD8⁺ T-lymphocyte ratio in early-stage VSCC. Formalin-fixed, paraffin-embedded tissue samples from 84 patients diagnosed with vulvar carcinoma in situ or invasive cancer stage IA–IB and treated surgically between 2015 and 2025 were analyzed. Immunohistochemical staining for CD4 and CD8 was performed, and the CD4⁺/CD8⁺ ratio was calculated. Recurrence-free survival was assessed using Kaplan–Meier analysis and Cox proportional hazards models.
During a mean follow-up of 33 months, disease recurrence occurred in 59.5% of patients. A CD4⁺/CD8⁺ ratio >1 was significantly associated with improved recurrence-free survival, both in univariate analysis (HR 0.45; p=0.008) and after adjustment for lymphocytic infiltrate density, CD8⁺ localization, p16 status, and histology (HR 0.39; p=0.010). An intense immune infiltrate was also independently protective.
These findings suggest that a favorable CD4⁺/CD8⁺ ratio represents an independent prognostic marker in early vulvar cancer. Immune profiling may therefore support risk stratification and contribute to more personalized management strategies in this disease.