Human papilloma virus associated carcinoma penis: a comparative study for histopathological correlation and outcome analysis
Keywords:Penile cancer, India, HPV positive, Disease free survival, P16 immunostaining
Background: Penile cancer prevalence is higher in the developing countries like Africa, Asia and South America as compared to western countries. HPV (human papilloma virus) DNA is detectable in about 50% of all penile cancer in India. The aim of the study was to compare tumour depth, lymph node metastasis and lymphovascular invasion and other high risk features in HPV positive penile cancer patients to HPV negative penile cancer patients.
Methods: This prospective, comparative study was done at Mahavir cancer sansthan a tertiary cancer centre in Patna (India). Biopsy proven cases of HPV positive and HPV negative penile cancer were compared for histological parameters and disease free survival. Statistical analysis was performed using NCSS 12 version 12.0.5 software. Kaplan- Meir survival analysis was done for disease free survival.
Results: On bivariate analysis, factors associated with HPV positivity were histological subtype (p=0.00001), grade of tumour (p=0.00698), depth of invasion (p=0.00001) and P16 status (p=0.00001). Depth of invasion (p=0.0499) and P16 status (p=0.00001) were the only independent factors associated with HPV status on multivariate analysis. There was no significant difference in 2 year disease free survival between the two groups, 91.57% vs 87.95% (p=0.4166 ).
Conclusions: Large proportion of penile cancer is associated with HPV in India. HPV associated penile cancer are highly invasive with predominant warty–basaloid histology. P16 immunostaining is strongly associated with HPV tumour. There is no survival advantage in HPV associated penile cancer as compared to HPV negative penile cancer.
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