Human papilloma virus associated carcinoma penis: a comparative study for histopathological correlation and outcome analysis

Authors

  • Akash K. Singh Department of Surgical Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
  • B. B. Pandey Department of Surgical Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
  • Naresh Jangir Department of Surgical Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India

DOI:

https://doi.org/10.18203/2349-2902.isj20193322

Keywords:

Penile cancer, India, HPV positive, Disease free survival, P16 immunostaining

Abstract

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. 

References

Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ. Penile cancer: epidemiology, pathogenesis and prevention. World J Urol. 2009;27(2):141.

Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N. EAU guidelines on penile cancer: 2014 update. Eur Urol. 2015;67(1):142-50.

Available at: http://www.indiacancersurgerysite. com/penile-cancer-treatment-india.html. Accessed on 3 June 2019.

Human Papillomavirus and Related Diseases Report. Available at: www.hpvcentre.net/statistics/ reports/XWX.pdf. Accessed on 18 June 2019.

Bansal A, Singh MP, Rai B. Human papillomavirus-associated cancers: A growing global problem. International Journal of Applied and Basic Medical Research. 2016;6(2):84.

Gross G, Pfister H. Role of human papillomavirus in penile cancer, penile intraepithelial squamous cell neoplasias and in genital warts. Med Microbiol Immunol. 2004;193(1):35-44.

Junker K, Hölters S, Hartmann A. Human Papilloma Virus, Histopathological, and Molecular Subtyping in Penile Cancer: Relevance for Prognosis and Therapy. European Urology Supplements. 2017;16(12):295-300.

Zhu Y, Zhang HL, Yao XD, Zhang SL, Dai B, Shen YJ, et al. Development and evaluation of a nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes. J Urol. 2010;184(2):539-45.

Bhagat SK, Walter N, Gopalakrishnan G. Predicting inguinal metastases in cancer penis. Indian J Urol. 2006;22(4):351.

Prowse DM, Ktori EN, Chandrasekaran D, Prapa A, Baithun S. Human papillomavirus‐associated increase in p16INK4A expression in penile lichen sclerosus and squamous cell carcinoma. Br J Dermatol. 2008;158(2):261-5.

Djajadiningrat RS, Jordanova ES, Kroon BK, van Werkhoven E, de Jong J, Pronk DT, Snijders PJ, Horenblas S, Heideman DA. Human papillomavirus prevalence in invasive penile cancer and association with clinical outcome. J Urol. 2015;193(2):526-31.

Lont AP, Kroon BK, Horenblas S, Gallee MP, Berkhof J, Meijer CJ, et al. Presence of high‐risk human papillomavirus DNA in penile carcinoma predicts favorable outcome in survival. Int J Cancer. 2006;119(5):1078-81.

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Published

2019-07-25

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Original Research Articles