1
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Tekin B, Cubilla AL, Cheville JC, Smith CY, Jenkins SM, Dasari S, Enninga EAL, Norgan AP, Menon S, Whaley RD, Hernandez LH, Jimenez RE, Garcia JJ, Thompson RH, Leibovich BC, Karnes RJ, Boorjian SA, Pagliaro LC, Erickson LA, Guo R, Gupta S. High-risk human papilloma virus status & outcomes for penile squamous cell carcinoma: A single institution experience. Hum Pathol 2024; 150:9-19. [PMID: 38909709 DOI: 10.1016/j.humpath.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES There is a paucity of data on North American cohorts of patients with penile squamous cell carcinoma (pSCC). Herein, we aimed to assess the sensitivity of various modalities to identify human papillomavirus (HPV) status, determine the prevalence of high-risk HPV-positivity, and evaluate the prognostic impact of relevant clinicopathologic variables. METHODS Patients with pSCC (n = 121) consecutively treated with partial/total penectomy (2000-2022) at a single institution were included. HPV status (based on immunohistochemistry [IHC], in situ hybridization [ISH], and panviral metagenomic sequencing [PMS]), histologic features, and outcomes were reviewed. Outcome events included death due to disease and progression. RESULTS The majority of patients were white (105/121, 86.8%). Thirty-seven (30.6%) were high-risk HPV-positive, and morphologic evaluation had a sensitivity of 97.3% (95% confidence interval [CI], 86.2-99.5) for predicting high-risk HPV status compared to IHC/ISH/PMS. Disease progression was more common among high-risk HPV-negative compared to high-risk HPV-positive patients (HR 2.74, CI 1.12-8.23, P = 0.03). Moreover, among high-risk HPV-negative patients, those with moderate-poorly differentiated tumors had increased disease-specific mortality (32.6%, CI 17.1-48.1) compared to those with well-differentiated tumors (0%). Among high-risk HPV-positive patients, those with basaloid morphology had lower disease-specific mortality (0% vs 14.4%, CI 0.0-33.1). CONCLUSIONS We demonstrate high-risk HPV-positivity in approximately one-third of patients with pSCC. Morphologic evaluation alone had a high sensitivity in correctly determining HPV status. Our results suggest that high-risk HPV status and morphologic features (differentiation in high-risk HPV-negative, and basaloid subtype in high-risk HPV-positive pSCC) may have prognostic value.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Antonio L Cubilla
- Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Carin Y Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MM, USA.
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MM, USA.
| | - Surendra Dasari
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | | | - Andrew P Norgan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Lance C Pagliaro
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, USA.
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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2
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Mink JN, Khalmurzaev O, Pryalukhin A, Hölters S, Geppert C, Lohse S, Bende K, Lobo J, Henrique R, Loertzer H, Steffens J, Jerónimo C, Wunderlich H, Heinzelbecker J, Bohle R, Stöckle M, Matveev V, Hartmann A, Junker K. [Importance of HPV status and p16 for the prognosis of penile carcinoma]. Aktuelle Urol 2023; 54:274-284. [PMID: 37541236 DOI: 10.1055/a-2104-1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
BACKGROUND Penile cancer is a rare but often lethal tumour disease, especially in the metastatic stage. Most data on prognostic factors for penile cancer are based on small patient cohorts, and even meta-analyses are mostly limited in terms of patient numbers. There is a lack of sufficient parameters to predict the metastatic risk of these tumours. Furthermore, the role of the HPV status for the prognosis, and, in this regard, of p16INK4a is still unclear. MATERIAL AND METHODS In this study, 236 patients from an international multicentre cohort were analysed with regard to histological subtypes, HPV and p16 status, and other clinical parameters. The HPV status was only graded as HPV-positive if HPV was detected by PCR and the p16 status defined by immunochemistry was positive. The statistical analysis was carried out using the Kaplan-Meier method as well as the log-rank test and a univariable and multivariable analysis using the Cox regression model. RESULTS A positive HPV status was not a significant parameter for either metastasis-free (MFS), tumour-specific (CSS) or overall survival (OS). p16-positive tumours showed a significantly better MFS (p=0.026), which was also confirmed in the subgroup analysis of HPV-negative tumours (p=0.037) without differences in CSS or OS. In the usual type, there was also a trend towards an improved MFS, but without statistical significance (p=0.070). p16-positive tumours were associated with a highly significantly better MFS (hazard ratio 0.3; p=0.004) in the multivariable Cox regression, while patients with a pT1b tumour stage or advanced lymph node metastasis showed a significantly worse survival. In the multivariable analysis of HPV-negative tumours, p16 status was also confirmed as an independent predictor of MFS (Hazard ratio 0.2; p=0.007). CONCLUSION HPV status alone seems to be lacking prognostic relevance. In contrast, p16 status was confirmed as an independent prognostic factor. Thus, the expression of p16INK4a is associated with a significantly better MFS. Especially in HPV-negative tumours, the p16 status should be evaluated with regard to the prognostic value and thus also with a view to the treatment decision.
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Affiliation(s)
- Jan Niklas Mink
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Oybek Khalmurzaev
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
- Abteilung für Urologie, N N Blokhin NMRCO, Moskva, Russian Federation
| | - Alexey Pryalukhin
- Abteilung für Pathologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
- Institut für Pathologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Sebastian Hölters
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Carol Geppert
- Institut für Pathologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Stefan Lohse
- Abteilung für Virologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Kristof Bende
- Institut für Pathologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - João Lobo
- Abteilung für Pathologie, IPO-PORTO, Porto, Portugal
| | - Rui Henrique
- Abteilung für Pathologie, IPO-PORTO, Porto, Portugal
| | - Hagen Loertzer
- Abteilung für Urologie und Kinderurologie, Westpfalz Klinikum Gmbh, Kaiserslautern, Deutschland
| | - Joachim Steffens
- Klinik für Urologie und Kinderurologie, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Carmen Jerónimo
- Abteilung für Pathologie, IPO-PORTO, Porto, Portugal
- Portuguese Oncology Institute of Porto, Research Center (CI-IPOP), Porto
| | - Heiko Wunderlich
- Abteilung für Urologie und Kinderurologie, St. Georg Klinikum Eisenach, Eisenach, Deutschland
| | - Julia Heinzelbecker
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Rainer Bohle
- Abteilung für Pathologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Michael Stöckle
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Vsevolod Matveev
- Abteilung für Urologie, N N Blokhin NMRCO, Moskva, Russian Federation
| | - Arndt Hartmann
- Institut für Pathologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Kerstin Junker
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
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Parza K, Mustasam A, Ionescu F, Paravathaneni M, Sandstrom R, Safa H, Grass GD, Johnstone PA, Eschrich SA, Chadha J, Zacharias N, Pettaway CA, Spiess PE, Chahoud J. The Prognostic Role of Human Papillomavirus and p16 Status in Penile Squamous Cell Carcinoma-A Systematic Review. Cancers (Basel) 2023; 15:3713. [PMID: 37509374 PMCID: PMC10378259 DOI: 10.3390/cancers15143713] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
PSCC is a rare cancer, with approximately half of all cases related to HPV. While HPV and p16 IHC testing have proven their prognostic value for oropharyngeal cancer, this is not yet established for PSCC. The current level of evidence exploring the relation between PSCC and HPV is moderate, so we conducted a systematic review following PRISMA guidelines to evaluate the prognostic role of HPV and p16 IHC in PSCC clinical outcomes. We searched the PubMed, Embase, and Cochrane databases and identified 34 relevant studies that met our inclusion criteria. Of these, 33 were retrospective cohort studies, and one was a cross-sectional study. Nine studies reported that HPV-positive and p16-positive PSCC had better overall survival (OS) and disease-free survival (DFS). This study highlights the need for a meta-analysis to determine the role of routine HPV status or p16 staining testing as part of the initial diagnosis and staging of PSCC patients worldwide.
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Affiliation(s)
- Kevin Parza
- Internal Medicine, USF Health Morsani College of Medicine, Tampa, FL 33601, USA
| | - Arfa Mustasam
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Filip Ionescu
- Internal Medicine, USF Health Morsani College of Medicine, Tampa, FL 33601, USA
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Mahati Paravathaneni
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Reagan Sandstrom
- Graduate Medication Education, USF Health Morsani College of Medicine, Tampa, FL 33602, USA
| | - Houssein Safa
- Hematology Oncology Department, Baylor College of Medicine, Houston, TX 77001, USA
| | - G Daniel Grass
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Peter A Johnstone
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Steven A Eschrich
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Juskaran Chadha
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Niki Zacharias
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX 77001, USA
| | - Curtis A Pettaway
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX 77001, USA
| | - Philippe E Spiess
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Jad Chahoud
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
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4
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Gamboa-Hoil SI. Human papillomavirus in men. Rev Int Androl 2023; 21:100325. [PMID: 36257902 DOI: 10.1016/j.androl.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/11/2021] [Accepted: 09/19/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To describe the clinical behavior of human papillomavirus in men. MATERIALS AND METHODS Current international literature was reviewed to describe the clinical behavior of human papillomavirus in men. RESULTS Internationally, the overall prevalence of HPV DNA is 50.8%, HPV considered high risk are 14 types. Prevalence of HPV DNA in invasive penile cancer ranges from 33.1% to 47%. HPV-16 has been the most frequent (68.3%), followed by HPV-6 (8.1%) and HPV-18 (6.9%). Positive HPV is described as an independent prognostic factor for cancer-specific survival. CONCLUSION It is not clear why HPV infection has a predilection in specific areas of the genital tract. However, it is important to note that there are factors that increase the risk of HPV infection.
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5
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Tekin B, Guo R, Cheville JC, Canete-Portillo S, Sanchez DF, Fernandez-Nestosa MJ, Dasari S, Menon S, Herrera-Hernandez L, Jimenez RE, Erickson LA, Cubilla AL, Gupta S. Penile squamous cell carcinoma exclusive to the shaft, with a proposal for a novel staging system. Hum Pathol 2022; 134:92-101. [PMID: 36566905 DOI: 10.1016/j.humpath.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Penile squamous cell carcinomas (SCC) originating in the shaft are rare. pT1/pT2 categories in the American Joint Committee on Cancer (AJCC) staging manual (8th edition) are poorly defined for SCCs arising in the dorsal shaft as anatomic structures differ between the glans and dorsal shaft (corpus spongiosum vs dartos/Buck's fascia, respectively). We reviewed six penile SCC cases exclusive to the shaft, an unusual presentation, identified amongst 120 patients treated with penectomy. We propose a novel pT staging system for dorsal shaft tumors tailored to its anatomic landmarks, where tumors extending to Buck's fascia are considered pT2 instead of pT1. The mean age at penectomy, average duration of follow-up, and mean depth of invasion were 64 years, 45 months, and 9.8 mm, respectively. Four cases were moderately differentiated, HPV-negative SCCs of the usual type and two cases were HPV-positive basaloid and warty-basaloid carcinomas. Three cases had nodal or distant metastasis at the time of penectomy, and histologic assessment in these cases showed invasion into the Buck's fascia or deeper. According to the current AJCC system, only one of these three cases would be staged as ≥ pT2. In contrast, all three metastatic tumors would be staged as ≥ pT2 in the proposed model. At last follow-up, one patient died of disease-related complications. Based on this limited series, the proposed staging model appears to suggest better patient stratification for pT1/pT2 stages. This model incorporates Buck's fascia, which has been postulated as a pathway of tumor infiltration. Additional studies are needed to validate this model.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Sofia Canete-Portillo
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
| | - Diego F Sanchez
- Instituto de Patología e Investigación, Asunción, 1228, Paraguay.
| | | | - Surendra Dasari
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India.
| | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | | | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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6
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Chadha J, Chahoud J, Spiess PE. An update on treatment of penile cancer. Ther Adv Med Oncol 2022; 14:17588359221127254. [PMID: 36172172 PMCID: PMC9511530 DOI: 10.1177/17588359221127254] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Penile cancer is a rare malignancy, particularly in industrialized nations. In the United States, rates are approximately less than 1 per 100,000 men per year with just over 2000 new cases per year. However, there is significantly increased prevalence in developing nations, with limited treatment expertise and reduced access to care, further driving an unmet clinical need. The most noteworthy risk factor for penile cancer is the association with human papillomavirus infection, which may be present in up to 50% of all penile carcinomas. In addition to local primary tumor approaches, multimodality treatment strategies are vital to patients with clinical regional nodal disease, locally advanced disease. Presence and degree of lymph node involvement remains the most important prognostic factor and patients may benefit from multiple treatment strategies. Interim analysis data from the first randomized clinical trial is expected to yield results in mid/late 2024–early 2025. These treatment approaches include neoadjuvant chemotherapy, adjuvant therapy, including chemotherapy and radiation. Systemic therapy for distant recurrent or metastatic disease is primarily a platinum-based chemotherapy, however with poor overall response. As poor outcomes remain high, particularly in indigent populations, there remains an unmet need for these patients, particularly for high level randomized trials and novel therapeutics. In this review, we will highlight treatment updates for penile cancer. In addition to standard of care, we will review novel lines of therapies including immunotherapies and targeted therapies as well as sequencing approaches.
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Affiliation(s)
- Juskaran Chadha
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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7
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Vieira GV, Somera dos Santos F, Lepique AP, da Fonseca CK, Innocentini LMAR, Braz-Silva PH, Quintana SM, Sales KU. Proteases and HPV-Induced Carcinogenesis. Cancers (Basel) 2022; 14:cancers14133038. [PMID: 35804810 PMCID: PMC9264903 DOI: 10.3390/cancers14133038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Human papillomavirus (HPV) infection is a sexually transmitted disease with high prevalence worldwide. Although most HPV infections do not lead to cancer, some HPV types are correlated with the majority of cervical cancers, and with some anogenital and oropharyngeal cancers. Moreover, enzymes known as proteases play an essential role in the pathogenic process in HPV-induced carcinogenesis. This review highlights the role of proteases and recent epidemiological data regarding HPV-dependent carcinogenesis. Abstract Persistent infection with Human papillomavirus (HPV) is the main etiologic factor for pre-malignant and malignant cervical lesions. Moreover, HPV is also associated with oropharynx and other anogenital carcinomas. Cancer-causing HPV viruses classified as group 1 carcinogens include 12 HPV types, with HPV 16 and 18 being the most prevalent. High-risk HPVs express two oncoproteins, E6 and E7, the products of which are responsible for the inhibition of p53 and pRB proteins, respectively, in human keratinocytes and cellular immortalization. p53 and pRB are pleiotropic proteins that regulate the activity of several signaling pathways and gene expression. Among the important factors that are augmented in HPV-mediated carcinogenesis, proteases not only control processes involved in cellular carcinogenesis but also control the microenvironment. For instance, genetic polymorphisms of matrix metalloproteinase 1 (MMP-1) are associated with carcinoma invasiveness. Similarly, the serine protease inhibitors hepatocyte growth factor activator inhibitor-1 (HAI-1) and -2 (HAI-2) have been identified as prognostic markers for HPV-dependent cervical carcinomas. This review highlights the most crucial mechanisms involved in HPV-dependent carcinogenesis, and includes a section on the proteolytic cascades that are important for the progression of this disease and their impact on patient health, treatment, and survival.
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Affiliation(s)
- Gabriel Viliod Vieira
- Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (G.V.V.); (C.K.d.F.); (L.M.A.R.I.)
| | - Fernanda Somera dos Santos
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (F.S.d.S.); (S.M.Q.)
| | - Ana Paula Lepique
- Department of Immunology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo 05508-000, SP, Brazil;
| | - Carol Kobori da Fonseca
- Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (G.V.V.); (C.K.d.F.); (L.M.A.R.I.)
| | - Lara Maria Alencar Ramos Innocentini
- Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (G.V.V.); (C.K.d.F.); (L.M.A.R.I.)
- Clinical Hospital of Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Paulo Henrique Braz-Silva
- Department of Stomatology, School of Dentistry, University of Sao Paulo, São Paulo 05508-000, SP, Brazil;
- Laboratory of Virology, Institute of Tropical Medicine of Sao Paulo, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (F.S.d.S.); (S.M.Q.)
| | - Katiuchia Uzzun Sales
- Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (G.V.V.); (C.K.d.F.); (L.M.A.R.I.)
- Correspondence: ; Tel.: +55-16-3315-9113
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8
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Escande A, Peiffert D, Dejean C, Hannoun-Lévi JM, Cordoba A, Pommier P, Haie-Méder C, Chargari C. Radiotherapy for penile cancers. Cancer Radiother 2021; 26:323-328. [PMID: 34953715 DOI: 10.1016/j.canrad.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Penile cancers are uncommon and should be treated in expert center. Radiotherapy indications are mainly limited to exclusive brachytherapy for early stage penile glans cancer. Brachytherapy yields to excellent outcome for disease control and organ and function preservation. Only scarce data are available for external beam radiation therapy. It could be considered as palliative setting for irradiation of the primary tumor. For lymph node irradiation, external beam radiation therapy (with or without chemotherapy) could be discussed either as neoadjuvant approach prior to surgery for massive inguinal lymph node invasion or as adjuvant approach in case of high-risk of relapse. However, these cases should be discussed on an individual basis, as the level of evidence is poor. We present the recommendations of the French Society of Oncological Radiotherapy on the indications and techniques for external beam radiotherapy and brachytherapy for penile glans cancer.
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Affiliation(s)
- A Escande
- Département de radiothérapie, centre Oscar-Lambret, 3, avenue Frédéric-Combemale, 59000 Lille, France; Faculté de médecine Henri-Warembourg, université de Lille, 59000 Lille, France; Laboratoire Cristal, UMR 9189, 59009 Villeneuve-d'Ascq, France.
| | - D Peiffert
- Département d'oncologie radiothérapie, institut de cancérologie de Lorraine centre Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - C Dejean
- Département d'oncologie radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06000 Nice, France
| | - J-M Hannoun-Lévi
- Département d'oncologie radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06000 Nice, France
| | - A Cordoba
- Département de radiothérapie, centre Oscar-Lambret, 3, avenue Frédéric-Combemale, 59000 Lille, France
| | - P Pommier
- Département d'oncologie radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France
| | - C Haie-Méder
- Département d'oncologie radiothérapie, centre de cancérologie, Charlebourg la Défense, 65, avenue Foch, 92250 La Garenne Colombes, France
| | - C Chargari
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France; École du Val-de-Grâce, boulevard de Port-Royal, 75005 Paris, France; Département des effets biologiques des rayonnements, institut de recherche biomédicale des armées, 91223 Brétigny-sur-Orge, France
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9
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Current management and future perspectives of penile cancer: An updated review. Cancer Treat Rev 2020; 90:102087. [PMID: 32799062 DOI: 10.1016/j.ctrv.2020.102087] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
Penile cancer (PeCa) is a rare disease worldwide, accounting for less than one percent of all malignancies in men. It usually presents as a painless ulcer or lump on the head of the penis. Squamous cell carcinoma represents the most common histological subtype of PeCa, with pathogenesis intimately linked to chronic Human Papilloma Virus (HPV) infection. Surgery is the cornerstone for the treatment of primary PeCa with potential mutilating outcome depending on the nodal extension of the disease. However, in case of extensive lymph node involvement, multidisciplinary treatment including perioperative chemotherapy and inclusion in clinical trial should be considered. To date, advanced or metastatic disease still have poor prognosis and are a therapeutic challenge with limited options, highlighting the need of new treatments and further investigations. Growing efforts to identify molecular alterations, understand the role of HPV and characterize immune contexture have expanded over the past years, providing further perspectives in prognostication, predictive biomarkers and therapeutic intervention. In this review, we provide an updated overview of current management of PeCa focusing on perioperative strategy. We discuss about new insights of the biology of PeCa and comment future directions in the field.
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Ashley S, Shanks JH, Oliveira P, Lucky M, Parnham A, Lau M, Sangar V. Human Papilloma Virus (HPV) status may impact treatment outcomes in patients with pre-cancerous penile lesions (an eUROGEN Study). Int J Impot Res 2020; 33:620-626. [DOI: 10.1038/s41443-020-0327-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/08/2020] [Accepted: 07/09/2020] [Indexed: 02/03/2023]
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Chahoud J, Pickering CR, Pettaway CA. Genetics and penile cancer: recent developments and implications. Curr Opin Urol 2020; 29:364-370. [PMID: 31045928 DOI: 10.1097/mou.0000000000000640] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW We summarize the recent developments in the molecular landscape of penile squamous cell carcinoma (PSCC). RECENT FINDINGS Recent genomic studies have demonstrated a molecular convergence of PSCC with other squamous cell carcinomas (SCCs) from different organ sites. Similarly, human papillomavirus (HPV)-related PSCCs appear to have epigenetic and genomic similarities with other HPV-related cancers. This could have implications on future HPV-related cancer trial design. Growing efforts to characterize recurrent gene alterations in PSCC have expanded our understanding over the past years, showing a predominance of tumor suppressor gene alterations such as TP53 and NOTCH1. In addition, these studies have demonstrated that at least 30% of PSCC cases have targetable gene alterations. Further, the similar tumor mutational burden with other SCCs and the relatively high rates of programmed death-1 (PD-1) positive expression in PSCC constitute the rationale for investigation of PD-1 inhibition in ongoing clinical trials. Multiple studies have identified potential epigenetic and RNA signatures predictive of metastasis or survival, but these still require validation in larger cohorts. SUMMARY PSCC appears to be genomicaly similar to other SCCs and HPV-related cancers. This provides the rationale and opportunity to include a rare tumor like PSCC in future 'basket type' trials using novel agents targeting multiple SCCs that may exhibit similar biology.
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Affiliation(s)
| | | | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Eich ML, Del Carmen Rodriguez Pena M, Schwartz L, Granada CP, Rais-Bahrami S, Giannico G, Amador BM, Matoso A, Gordetsky JB. Morphology, p16, HPV, and outcomes in squamous cell carcinoma of the penis: a multi-institutional study. Hum Pathol 2019; 96:79-86. [PMID: 31698006 DOI: 10.1016/j.humpath.2019.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022]
Abstract
Our objective was to evaluate the pathologic features and clinical outcomes in cases of invasive penile squamous cell carcinoma (SCC) and the association with p16 immunohistochemistry (IHC) and human papilloma virus (HPV) in situ hybridization (ISH). A retrospective multi-institutional database search was conducted for invasive SCC of the penis diagnosed between 2007 and 2018 that had undergone surgical resection. Pathologic features, p16 IHC, and HPV ISH were investigated with clinical outcomes. A total of 102 patients were included in the study. The average age was 63 ± 13.3 years. Based on histology, 46% of tumors displayed an HPV-related subtype, whereas p16 was positive in 52% of all cases. Tumor histology correlated well with p16 positivity (P < .001), and p16 IHC accurately predicted the presence of HPV in 25/26 (96%) cases. On multivariate analysis, perineural invasion was associated with local disease recurrence (P = .02), whereas lymphovascular invasion was associated with progression to metastatic disease (P = .002) and increased overall mortality (P = .02). Urethral involvement was also associated with increased overall mortality (P = .02). In addition, HPV-related tumors based on histologic features correlated with lower rates of metastatic disease (P = .007). HPV is a common cause of penile SCC and can be diagnosed by tumor histology and confirmed by overexpression of p16 on IHC. The presence of lymphovascular invasion, perineural invasion, and urethral involvement are poor prognostic indicators, whereas HPV-related tumors based on histology may have lower risk for metastatic disease.
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Affiliation(s)
- Marie-Lisa Eich
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, 35294 USA
| | | | - Lauren Schwartz
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Carlos Prieto Granada
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, 35294 USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, 35294 USA; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294 USA; O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, 35294 USA
| | - Giovanna Giannico
- Department of Pathology, Vanderbilt University, Nashville, TN, 37212 USA
| | | | - Andres Matoso
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21287 USA
| | - Jennifer B Gordetsky
- Department of Pathology, Vanderbilt University, Nashville, TN, 37212 USA; Department of Urology, Vanderbilt University, Nashville, TN, 37212 USA.
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Olesen TB, Sand FL, Rasmussen CL, Albieri V, Toft BG, Norrild B, Munk C, Kjær SK. Prevalence of human papillomavirus DNA and p16 INK4a in penile cancer and penile intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol 2018; 20:145-158. [PMID: 30573285 DOI: 10.1016/s1470-2045(18)30682-x] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/25/2018] [Accepted: 09/04/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although previous meta-analyses have examined human papillomavirus (HPV) DNA prevalence in penile cancer, none, to our knowledge, have assessed pooled HPV DNA prevalence in penile intraepithelial neoplasia or p16INK4a percent positivity in penile cancer and penile intraepithelial neoplasia. Therefore, we aimed to examine the prevalence of HPV DNA and p16INK4a positivity in penile cancer and penile intraepithelial neoplasia worldwide. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Library until July 24, 2017, for English-language articles published from Jan 1, 1986, onwards reporting the prevalence of HPV DNA and p16INK4a positivity, either alone or in combination, in at least five cases of penile cancer or penile intraepithelial neoplasia. Only studies that used PCR or hybrid capture for the detection of HPV DNA and immunohistochemical staining or methylation for the detection of p16INK4a were included. Data were extracted and subsequently crosschecked, and inconsistencies were discussed to reach consensus. Using random-effects models, we estimated the pooled prevalence and 95% CI of HPV DNA and p16INK4a positivity in penile cancer and penile intraepithelial neoplasia, stratifying by histological subtype and HPV DNA or p16INK4a detection method. Type-specific prevalence of HPV6, HPV11, HPV16, HPV18, HPV31, HPV33, and HPV45 in penile cancer was estimated. FINDINGS Our searches identified 1836 non-duplicate records, of which 73 relevant papers (71 studies) were found to be eligible. The pooled HPV DNA prevalence in penile cancer (52 studies; n=4199) was 50·8% (95% CI 44·8-56·7; I2=92·6%, pheterogeneity<0·0001). A high pooled HPV DNA prevalence was seen in basaloid squamous cell carcinomas (84·0%, 95% CI 71·0-93·6; I2=48·0%, pheterogeneity=0·0197) and in warty-basaloid carcinoma (75·7%, 70·1-81·0; I2=0%, pheterogeneity=0·52). The predominant oncogenic HPV type in penile cancer was HPV16 (68·3%, 95% CI 58·9-77·1), followed by HPV6 (8·1%, 4·0-13·7) and HPV18 (6·9%, 2·9-12·4). The pooled HPV DNA prevalence in penile intraepithelial neoplasia (19 studies; n=445) was 79·8% (95% CI 69·3-88·6; I2=83·2%, pheterogeneity<0·0001). The pooled p16INK4a percent positivity in penile cancer (24 studies; n=2295) was 41·6% (95% CI 36·2-47·0; I2=80·6%, pheterogeneity<0·0001), with a high pooled p16INK4a percent positivity in HPV-related squamous cell carcinoma (85·8%, 95% CI 72·1-95·4; I2=56·4%, pheterogeneity=0·0011) as compared with non-HPV-related squamous cell carcinoma (17·1%, 7·9-29·1; I2=78·3%, pheterogeneity<0·0001). Moreover, among HPV-positive cases of penile cancer, the p16INK4a percent positivity was 79·6% (95% CI 65·7-90·7; I2=89·9%, pheterogeneity<0·0001), compared with 18·5% (9·6-29·6; I2=89·3%, pheterogeneity<0·0001) in HPV-negative penile cancers. The pooled p16INK4a percent positivity in penile intraepithelial neoplasia (six studies; n=167) was 49·5% (95% CI 18·6-80·7). INTERPRETATION A large proportion of penile cancers and penile intraepithelial neoplasias are associated with infection with HPV DNA (predominantly HPV16), emphasising the possible benefits of HPV vaccination in men and boys. FUNDING None.
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Affiliation(s)
- Tina Bech Olesen
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Freja Lærke Sand
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | | | - Vanna Albieri
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | | | - Bodil Norrild
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Susanne Krüger Kjær
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Martins VDA, Pinho JD, Teixeira Júnior AAL, Nogueira LR, Silva FF, Maulen VE, Khayat AS, Calixto JDRR, Costa HA, Ramalho LNZ, Silva GEB. P16INK4a expression in patients with penile cancer. PLoS One 2018; 13:e0205350. [PMID: 30312320 PMCID: PMC6185731 DOI: 10.1371/journal.pone.0205350] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Infection with human papillomavirus (HPV) is reported to be present in 30-50% of penile cancer cases. The immunohistochemical test for p16INK4a is used as an indicator of the presence of HPV and as a prognostic marker for squamous cell carcinomas in various sites. However, the role of this marker in penile carcinoma has not yet been completely elucidated. The aim of this study was to analyze whether the expression of p16INK4a is associated with the presence of HPV, histological parameters, and survival in penile cancer. METHODS A study was conducted from 2014 to 2016 that included 55 patients with penile carcinoma. HPV DNA was detected through PCR using fresh tumor tissue, and immunohistochemistry was performed for analysis of p16INK4a protein using paraffin-embedded tissue. Evaluation of histological parameters was performed following complete embedding of the tumor tissue in paraffin. RESULTS HPV DNA (low-risk and high-risk genotypes) was found in 49 (89.1%) cases, and 46/49 (93.9%) showed high-oncogenic risk HPV (HR-HPV). Of the 22 cases positive for p16INK4a, HR-HPV DNA was present in 21 (95.5%) (p = 0.032). Regarding histological parameters, p16INK4a and HR-HPV were significantly associated only with tumor subtype (p = 0.036 and p = 0.032, respectively); all carcinomas with basaloid characteristics were positive for p16INK4a. Although HPV+ patients had a higher disease-free survival (p <0.001), p16INK4a expression was not associated with patient survival. CONCLUSIONS Our study, using fresh tissue samples, showed the highest incidence of HPV compared to that observed in the literature. Expression of the p16INK4a protein was significantly associated with the presence of HR-HPV and this expression may serve as a marker for the presence of the virus. The p16INK4a protein was not associated with the histological prognostic parameters, with the exception of tumor subtype, nor with patient survival. In the results, we showed that the objective of the present study was reached.
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Affiliation(s)
- Vicenilma de Andrade Martins
- Postgraduate Program in Adult and Child Health (PPGSAC), Federal University of Maranhão (UFMA), São Luís, Brazil
| | - Jaqueline Diniz Pinho
- Postgraduate Program in Genetics and Molecular Biology (PPGBM), Federal University of Pará (UFPA), Belém, Brazil
| | | | | | - Fábio França Silva
- Northeast Network of Biotechnology Program (RENORBIO), State University of Ceará (UECE), Ceará, Brazil
| | | | - André Salim Khayat
- Postgraduate Program in Genetics and Molecular Biology (PPGBM), Federal University of Pará (UFPA), Belém, Brazil
| | | | - Herikson Araújo Costa
- Department of Physical Education, Federal University of Maranhão (UFMA), Pinheiro, Brazil
| | | | - Gyl Eanes Barros Silva
- Department of Pathology, Ribeirão Preto Medical of School, University of São Paulo (USP), Ribeirao Preto, Brazil
- * E-mail:
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REPLY. Urology 2018; 120:94-95. [DOI: 10.1016/j.urology.2018.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 11/22/2022]
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16
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Hakenberg OW, Dräger D, Erbersdobler A. Pathology, Molecular Biology, and Prognosis of Penile Squamous Cell Carcinoma: What Can We Learn from the Specimen? EUROPEAN UROLOGY SUPPLEMENTS 2018; 17:138-145. [DOI: 10.1016/j.eursup.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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17
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Prognostic Significance of P16 INK4a Expression in Penile Squamous Cell Carcinoma: A Meta-Analysis with Trial Sequential Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8345893. [PMID: 30105253 PMCID: PMC6076906 DOI: 10.1155/2018/8345893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 01/01/2023]
Abstract
Background Recently, P16INK4a expression has been shown to be correlated with cancer-specific survival (CSS) in penile squamous cell carcinoma (SCC). Therefore, we performed this meta-analysis to clarify the prognostic value of P16INK4a for penile SCC. Methods A systematic search was performed in PubMed, Embase, and Web of Science to identify all relevant articles up to May 25, 2017. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of included studies were pooled to estimate the prognostic value. Trial sequential analysis (TSA) was performed to assess the quantity and strength of survival evidence. Results Five retrospective studies consisting of 323 cases were finally included. We found that P16INK4a positive expression was significantly associated with a better CSS of penile SCC (HR=0.45, 95%CI: 0.30-0.67, P<0.001). No heterogeneity or publication bias was noted among the included studies. Furthermore, TSA demonstrated that the findings were based on sufficient evidence. Conclusions P16INK4a positive expression is independently associated with improved CSS for patients with penile SCC.
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18
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Sand FL, Rasmussen CL, Frederiksen MH, Andersen KK, Kjaer SK. Prognostic Significance of HPV and p16 Status in Men Diagnosed with Penile Cancer: A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev 2018; 27:1123-1132. [DOI: 10.1158/1055-9965.epi-18-0322] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/07/2018] [Accepted: 07/02/2018] [Indexed: 11/16/2022] Open
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19
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May M, Brookman-May SD, Ecke TH, Burger M. Die molekulare Charakterisierung des Peniskarzinoms. Urologe A 2018; 57:398-407. [DOI: 10.1007/s00120-018-0596-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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Aita GA, Zequi SDC, Costa WHD, Guimarães GC, Soares FA, Giuliangelis TS. Tumor histologic grade is the most important prognostic factor in patients with penile cancer and clinically negative lymph nodes not submitted to regional lymphadenectomy. Int Braz J Urol 2017; 42:1136-1143. [PMID: 27813383 PMCID: PMC5117969 DOI: 10.1590/s1677-5538.ibju.2015.0416] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/21/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The presence and extension of inguinal lymph node metastasis are the main prognostic factors in patients with penile cancer. Physical exam and image exams are not adequate to evaluate inguinal lymph nodes and many patients are submitted to non-therapeutic lymphadenectomies. However, it is known that not all patients with clinically or histologically negative inguinal lymph nodes evolve favorably. CASUISTIC AND METHODS the authors evaluated the clinical and pathologic characteristics of 163 patients with penile carcinoma and clinically negative inguinal lymph nodes followed for three or more years and their impact on global survival (GS) and cancer-specific survival (CSS) in the 10-year follow-up. Primary pathologic tumor stage (p=0.025) and the presence of high grade of tumor differentiation (p=0.018) were predictive of CSS. The presence of high grade tumor was an independent specific prognostic factor of death risk (RR 14.08; p=0.019). CONCLUSION high histologic grade was an independent predictive factor of specific death risk in patients with penile carcinoma and clinically negative lymph nodes followed for three or more years.
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Affiliation(s)
- Giuliano Amorim Aita
- Departamento de Urologia, Hospital Universitário - Universidade Federal do Piauí, Brasil
| | - Stênio de Cássio Zequi
- Serviço de Urologia, Departamento de Cirurgia Pélvica, A C Camargo Cancer Center, SP, Brasil
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Abstract
Individuals with inherited immunodeficiencies, autoimmune disorders, organ or bone marrow transplantation, or infection with human immunodeficiency virus (HIV) are at increased risk of infection with both low-risk and high-risk human papillomavirus (HPV) types. Chronic immunosuppression provides an environment for persistent HPV infection which carries a higher risk of malignant transformation. Screening guidelines have been developed or advocated for processes that have detectable premalignant lesions, such as anal cancer or cervical cancer. For other anatomic locations, such as cutaneous, penile, and oropharyngeal, a biopsy of suspicious lesions is necessary for diagnosis. HPV cannot be cultured from clinical specimens in the laboratory, and diagnosis relies on cytologic, histologic, or molecular methods.
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McDaniel AS, Hovelson DH, Cani AK, Liu CJ, Zhai Y, Zhang Y, Weizer AZ, Mehra R, Feng FY, Alva AS, Morgan TM, Montgomery JS, Siddiqui J, Sadis S, Bandla S, Williams PD, Cho KR, Rhodes DR, Tomlins SA. Genomic Profiling of Penile Squamous Cell Carcinoma Reveals New Opportunities for Targeted Therapy. Cancer Res 2016; 75:5219-27. [PMID: 26670561 DOI: 10.1158/0008-5472.can-15-1004] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Penile squamous cell carcinoma (PeSCCA) is a rare malignancy for which there are limited treatment options due to a poor understanding of the molecular alterations underlying disease development and progression. Therefore, we performed comprehensive, targeted next-generation sequencing to identify relevant somatic genomic alterations in a retrospective cohort of 60 fixed tumor samples from 43 PeSCCA cases (including 14 matched primary/metastasis pairs). We identified a median of two relevant somatic mutations and one high-level copy-number alteration per sample (range, 0-5 and 0-6, respectively). Expression of HPV and p16 was detectable in 12% and 28% of patients, respectively. Furthermore, advanced clinical stage, lack of p16 expression, and MYC and CCND1 amplifications were significantly associated with shorter time to progression or PeSCCA-specific survival. Notably, four cases harbored EGFR amplifications and one demonstrated CDK4 amplification, genes for which approved and investigational targeted therapies are available. Importantly, although paired primary tumors and lymph node metastases were largely homogeneous for relevant somatic mutations, we identified heterogeneous EGFR amplification in primary tumor/lymph node metastases in 4 of 14 cases, despite uniform EGFR protein overexpression. Likewise, activating HRAS mutations occurred in 8 of 43 cases. Taken together, we provide the first comprehensive molecular PeSCCA analysis, which offers new insight into potential precision medicine approaches for this disease, including strategies targeting EGFR.
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Affiliation(s)
- Andrew S McDaniel
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Daniel H Hovelson
- Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Andi K Cani
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Chia-Jen Liu
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Yali Zhai
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Yajia Zhang
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Rohit Mehra
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Ajjai S Alva
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Javed Siddiqui
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Seth Sadis
- Thermo Fisher Scientific, Ann Arbor, Michigan
| | | | | | - Kathleen R Cho
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Daniel R Rhodes
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan. Thermo Fisher Scientific, Ann Arbor, Michigan
| | - Scott A Tomlins
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan. Department of Urology, University of Michigan, Ann Arbor, Michigan. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan.
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Hartz JM, Engelmann D, Fürst K, Marquardt S, Spitschak A, Goody D, Protzel C, Hakenberg OW, Pützer BM. Integrated Loss of miR-1/miR-101/miR-204 Discriminates Metastatic from Nonmetastatic Penile Carcinomas and Can Predict Patient Outcome. J Urol 2016; 196:570-8. [PMID: 26896570 DOI: 10.1016/j.juro.2016.01.115] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Penile squamous cell carcinoma is a rare but aggressive cancer. Little is known about pivotal events in tumor pathogenesis and metastasis. Lymph node metastasis is the prevailing prognostic factor while clinical detection in patients remains difficult. Our aim was to identify distinct miRNAs that are differentially expressed in metastatic vs nonmetastatic penile carcinoma, which may serve as diagnostic biomarkers for disease progression. MATERIALS AND METHODS TaqMan® arrays and quantitative polymerase chain reaction were applied to analyze miRNA profiles in penile squamous cell carcinoma specimens and glans tissue from 24 patients. The prognostic value of deregulated miRNAs was analyzed using the Kaplan-Meier method. The Spearman test was applied to determine a potential linkage between distinctive miRNAs in individual patients. RESULTS Loss of miR-1 (p = 0.0048), miR-101 (p = 0.0001) and miR-204 (p = 0.0004) in metastasizing tumors and associated metastases (p = 0.0151, 0.0019 and 0.0003, respectively) distinguished patients with metastatic and nonmetastatic penile squamous cell carcinoma. These 3 miRNAs showed a coherent expression pattern. Consistently, patients with low levels of all 3 miRNAs had worse survival (p = 0.03). We identified a coordinately regulated miRNA target hub that is over expressed in penile squamous cell carcinoma and associated with lymphovascular invasion. CONCLUSIONS Our results provide evidence of a novel multiple miRNA based signature associated with lymph node metastasis and unfavorable prognosis of penile squamous cell carcinoma. The integrated loss of miR-1, miR-101 and miR-204 may predict the formation of metastases in penile cancer at an early stage.
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Affiliation(s)
- Juliane M Hartz
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - David Engelmann
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany.
| | - Katharina Fürst
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Stephan Marquardt
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Alf Spitschak
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Deborah Goody
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Chris Protzel
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Oliver W Hakenberg
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Brigitte M Pützer
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
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Zargar-Shoshtari K, Spiess PE, Berglund AE, Sharma P, Powsang JM, Giuliano A, Magliocco AM, Dhillon J. Clinical Significance of p53 and p16(ink4a) Status in a Contemporary North American Penile Carcinoma Cohort. Clin Genitourin Cancer 2015; 14:346-51. [PMID: 26794389 DOI: 10.1016/j.clgc.2015.12.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Because of the low incidence of penile carcinoma (PC), the value of p16(ink4a), p53, and human papilloma virus (HPV) infection status in clinical practice remains unclear. Herein, we report our experience with potential clinical utility of these markers in men with PC treated at our institution. PATIENTS AND METHODS Tissue microarrays of 57 cases of invasive penile squamous cell carcinomas were immunohistochemically stained for p16 and p53. HPV in situ hybridization (ISH) for high-risk subtypes was also performed. Association between marker status, nodal disease, overall (OS) and cancer-specific survival (CSS) were assessed. RESULTS p16 and HPV ISH were positive in 23 (40%) and 24 (42%) of the cohort, respectively. The proportion of warty, basaloid, or mixed warty basaloid tumor subtypes were significantly greater in the p16-positive patients (48% vs. 3%; P < .01). p53 expression was negative in 31 (54%) cases. Only in p16-negative patients, positive p53 status was associated with pN+ disease (odds ratio, 4.4 [95% confidence interval (CI), 1.04-18.6]). In Kaplan-Meier analysis, the unadjusted estimated OS was insignificantly longer in p16-positive patients (median OS, 75 vs. 27 months; P = .27) and median CSS was not reached (P = .16). In a multivariable Cox proportional hazard model, when controlling for pathological nodal status and adjuvant chemotherapy, p16 status was a significant predictor for improved CSS (hazard ratio, 0.36 [95% CI, 0.13-0.99]). The worst CSS was seen in pN+ patients with double negative p16 and p53 expression (8 vs. 34 months; P = .01). CONCLUSION In this current cohort, p53 and p16 status showed clinical utility in predicting nodal disease as well as survival.
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Affiliation(s)
- Kamran Zargar-Shoshtari
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Anders E Berglund
- Department of Biomedical Informatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Pranav Sharma
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Julio M Powsang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Anna Giuliano
- Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Anthony M Magliocco
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jasreman Dhillon
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Lughezzani G, Catanzaro M, Torelli T, Piva L, Biasoni D, Stagni S, Necchi A, Giannatempo P, Raggi D, Fare' E, Colecchia M, Pizzocaro G, Salvioni R, Nicolai N. Relationship between lymph node ratio and cancer-specific survival in a contemporary series of patients with penile cancer and lymph node metastases. BJU Int 2015; 116:727-33. [DOI: 10.1111/bju.12510] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Giovanni Lughezzani
- Department of Urology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
- Department of Urology; San Raffaele Turro; Fondazione IRCCS Ospedale San Raffaele; Milan Italy
| | - Mario Catanzaro
- Department of Urology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Tullio Torelli
- Department of Urology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Luigi Piva
- Department of Urology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Davide Biasoni
- Department of Urology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Silvia Stagni
- Department of Urology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Andrea Necchi
- Department of Oncology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | | | - Daniele Raggi
- Department of Oncology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Elena Fare'
- Department of Oncology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Maurizio Colecchia
- Department of Pathology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Giorgio Pizzocaro
- Department of Pathology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Roberto Salvioni
- Department of Urology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Nicola Nicolai
- Department of Urology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
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Human papillomavirus infection and immunohistochemical p16INK4a expression as predictors of outcome in penile squamous cell carcinomas. Hum Pathol 2015; 46:532-40. [DOI: 10.1016/j.humpath.2014.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/08/2014] [Accepted: 12/17/2014] [Indexed: 11/20/2022]
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Lack of P16
ink4a
Over Expression in Penile Squamous Cell Carcinoma is Associated with Recurrence after Lymph Node Dissection. J Urol 2015; 193:519-25. [DOI: 10.1016/j.juro.2014.08.120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 11/22/2022]
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Barzon L, Cappellesso R, Peta E, Militello V, Sinigaglia A, Fassan M, Simonato F, Guzzardo V, Ventura L, Blandamura S, Gardiman M, Palù G, Fassina A. Profiling of expression of human papillomavirus-related cancer miRNAs in penile squamous cell carcinomas. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:3376-83. [PMID: 25455689 DOI: 10.1016/j.ajpath.2014.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/18/2014] [Accepted: 08/14/2014] [Indexed: 01/07/2023]
Abstract
Penile squamous cell carcinoma (PSCC) is a rare tumor associated with high-risk human papillomavirus (HR-HPV) infection in 30% to 60% of cases. Altered expression of miRNAs has been reported in HPV-related cervical and head and neck cancers, but such data have not been available for PSCC. We analyzed a series of 59 PSCCs and 8 condylomata for presence of HPV infection, for p16(INK4a), Ki-67, and p53 immunohistochemical expression, and for expression of a panel of cellular miRNAs (let-7c, miR-23b, miR-34a, miR-145, miR-146a, miR-196a, and miR-218) involved in HPV-related cancer. HR-HPV DNA (HPV16 in most cases) was detected in 17/59 (29%) PSCCs; all penile condylomata (8/8) were positive for low-risk HPV6 or HPV11. HR-HPV(+) PSCCs overexpressed p16(INK4a) in 88% cases and p53 in 35% of cases, whereas HR-HPV(-) PSCCs were positive for p16(INK4a) and p53 immunostaining in 9% and 44% of cases, respectively. Among the miRNAs investigated, expression of miR-218 was lower in PSCCs with HR-HPV infection and in p53(-) cancers. Hypermethylation of the promoter of the SLIT2 gene, which contains miR-218-1 in its intronic region, was frequently observed in PSCCs, mainly in those with low miR-218 expression. Epigenetic silencing of miR-218 is a common feature in HR-HPV(+) PSCCs and in HR-HPV(-) PSCCs without immunohistochemical detection of p53.
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Affiliation(s)
- Luisa Barzon
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | | | - Elektra Peta
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Valentina Militello
- Department of Molecular Medicine, University of Padua, Padua, Italy; Virology Unit, Parma University Hospital, Parma, Italy
| | - Alessandro Sinigaglia
- Department of Molecular Medicine, University of Padua, Padua, Italy; Veneto Region Oncology Institute (Istituto Oncologico Veneto-IRCCS), Padua, Italy
| | - Matteo Fassan
- Department of Medicine, University of Padua, Padua, Italy
| | | | | | - Laura Ventura
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | | | | | - Giorgio Palù
- Department of Molecular Medicine, University of Padua, Padua, Italy
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Pond GR, Di Lorenzo G, Necchi A, Eigl BJ, Kolinsky MP, Chacko RT, Dorff TB, Harshman LC, Milowsky MI, Lee RJ, Galsky MD, Federico P, Bolger G, DeShazo M, Mehta A, Goyal J, Sonpavde G. Prognostic risk stratification derived from individual patient level data for men with advanced penile squamous cell carcinoma receiving first-line systemic therapy. Urol Oncol 2013; 32:501-8. [PMID: 24332646 DOI: 10.1016/j.urolonc.2013.10.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 09/20/2013] [Accepted: 10/08/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prognostic factors in men with penile squamous cell carcinoma (PSCC) receiving systemic therapy are unknown. A prognostic classification system in this disease may facilitate interpretation of outcomes and guide rational drug development. We performed a retrospective analysis to identify prognostic factors in men with PSCC receiving first-line systemic therapy for advanced disease. PATIENTS AND METHODS Individual patient level data were obtained from 13 institutions to study prognostic factors in the context of first-line systemic therapy for advanced PSCC. Cox proportional hazards regression analysis was conducted to examine the prognostic effect of these candidate factors on progression-free survival (PFS) and overall survival (OS): age, stage, hemoglobin, neutrophil count, lymphocyte count, albumin, site of metastasis (visceral or nonvisceral), smoking, circumcision, regimen, ECOG performance status (PS), lymphovascular invasion, precancerous lesion, and surgery following chemotherapy. The effect of different treatments was then evaluated adjusting for factors in the prognostic model. RESULTS The study included 140 eligible men. Mean age across all men was 57.0 years. Among them, 8.6%, 21.4%, and 70.0% of patients had stage 2, 3, and 4 diseases, respectively; 40.7% had ECOG PS ≥ 1, 47.4% had visceral metastases, and 73.6% received cisplatin-based chemotherapy. The multivariate model of poor prognostic factors included visceral metastases (P<0.001) and ECOG PS ≥ 1 (P<0.001) for both PFS and OS. A risk stratification model constructed with 0, 1, and both poor prognostic factors was internally validated and demonstrated moderate discriminatory ability (c-statistic of 0.657 and 0.677 for OS and PFS, respectively). The median OS for the entire population was 9 months. Median OS was not reached, 8, and 7 months for those with 0, 1, and both risk factors, respectively. Cisplatin-based regimens were associated with better OS (P = 0.017) but not PFS (P = 0.37) compared with noncisplatin-based regimens after adjusting for the 2 prognostic factors. CONCLUSIONS In men with advanced PSCC receiving first-line systemic therapy, visceral metastases and ECOG PS ≥ 1 were poor prognostic factors. A prognostic model including these factors exhibited moderate discriminatory ability for outcomes and warrants external validation. Patients receiving cisplatin-based regimens exhibited better outcomes compared with noncisplatin-based regimens after adjusting for prognostic factors.
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Affiliation(s)
| | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Raju T Chacko
- Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | | | - Richard J Lee
- Masachussetts General Hospital Cancer Center, Boston, MA
| | | | | | - Graeme Bolger
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL
| | - Mollie DeShazo
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL
| | - Amitkumar Mehta
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL
| | - Jatinder Goyal
- Department of Medicine, UAB Medical Center, Birmingham, AL
| | - Guru Sonpavde
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL.
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Li D, Han Z, Liu J, Zhang X, Ren J, Yan L, Liu H, Xu Z. Upregulation of nucleus HDGF predicts poor prognostic outcome in patients with penile squamous cell carcinoma bypass VEGF-A and Ki-67. Med Oncol 2013; 30:702. [PMID: 23999841 DOI: 10.1007/s12032-013-0702-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/20/2013] [Indexed: 01/27/2023]
Abstract
Hepatoma-derived growth factor (HDGF) has been verified to serve as a credible prognostic marker for several types of cancers, but its role in urologic carcinomas remains undetermined. In this study, we analyzed the significance of HDGF, as well as its relative factors such as vascular endothelial growth factor-A (VEGF-A) and Ki-67, in penile squamous cell carcinoma (PSCC). Formalin-fixed paraffin-embedded PSCC samples from 54 patients receiving surgery at Qilu Hospital of Shandong University were included in the retrospective study. The expressions of HDGF, VEGF-A, and Ki-67 were detected by immunohistochemistry of a non-biotin polymerized horseradish peroxidase method. The relationships between the expressions of HDGF and VEGF-A, Ki-67 were assessed. Moreover, their correlations with clinical pathologic characteristics and disease prognosis were, respectively, evaluated. HDGF, VEGF-A, and Ki-67 were positively expressed in 28 (51.9%), 29 (53.7%), and 26 (48.1%) patients, respectively. The expressions of VEGF-A and Ki-67 were closely correlated with PSCC type (P < 0.05). A statistically significant relationship between the expressions of HDGF and VEGF-A in PSCC was observed (P = 0.03). Patients with symptom interval of more than 6 months had a significantly poorer survival rate than those with symptom interval less than 6 months (43.3 vs. 70.8%, P = 0.043). Patients with positive HDGF expression also showed a significantly poorer survival rate than those with negative HDGF expression (39.3 vs. 73.1%, P = 0.013). Logistic regression demonstrated that the expression level of HDGF was an independent predictor for the prognosis of postoperative patients. The expression of HDGF significantly correlated with VEGF-A, but not Ki-67 expression. Overexpression of HDGF, rather than VEGF-A or Ki-67, was confirmed to be an independent prognosticator of poor outcome for PSCC patients.
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Affiliation(s)
- Dawei Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China,
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May M, Burger M, Otto W, Hakenberg OW, Wieland WF, May D, Hofstädter F, Götz S, Niessl N, Fritsche HM, Birnkammer K, Gilfrich C, Peter J, Jain A, Koch S, Lebentrau S, Riedmiller H, Rössler W, Denzinger S, Brookman-May S, Gunia S. Ki-67, mini-chromosome maintenance 2 protein (MCM2) and geminin have no independent prognostic relevance for cancer-specific survival in surgically treated squamous cell carcinoma of the penis. BJU Int 2013; 112:E383-90. [DOI: 10.1111/j.1464-410x.2012.11735.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matthias May
- Department of Urology; St. Elisabeth Clinic Straubing; Straubing
| | - Maximilian Burger
- Department of Urology; Julius-Maximilians University Clinic Würzburg; Würzburg
| | | | | | - Wolf F. Wieland
- Department of Urology; St. Josef Caritas University Clinic Regensburg; Regensburg
| | - Dieter May
- Department of Pathology; DRK-Clinic Berlin-Köpenick; Berlin
| | | | - Stefanie Götz
- Laboratory for Experimental Urology; University Clinic Regensburg; Regensburg
| | - Nina Niessl
- Laboratory for Experimental Urology; University Clinic Regensburg; Regensburg
| | - Hans-Martin Fritsche
- Department of Urology; St. Josef Caritas University Clinic Regensburg; Regensburg
| | | | | | - Julia Peter
- Department of Urology; St. Elisabeth Clinic Straubing; Straubing
| | - Anjun Jain
- Department of Pathology; Helios-Clinic Bad Saarow; Bad Saarow
| | - Stefan Koch
- Department of Pathology; Helios-Clinic Bad Saarow; Bad Saarow
| | | | - Hubertus Riedmiller
- Department of Urology; Julius-Maximilians University Clinic Würzburg; Würzburg
| | - Wolfgang Rössler
- Department of Urology; St. Josef Caritas University Clinic Regensburg; Regensburg
| | - Stefan Denzinger
- Department of Urology; St. Josef Caritas University Clinic Regensburg; Regensburg
| | - Sabine Brookman-May
- Department of Urology; St. Josef Caritas University Clinic Regensburg; Regensburg
| | - Sven Gunia
- Department of Pathology; Johanniter Hospital Stendal; Stendal; Germany
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Sonpavde G, Pagliaro LC, Buonerba C, Dorff TB, Lee RJ, Di Lorenzo G. Penile cancer: current therapy and future directions. Ann Oncol 2013; 24:1179-89. [PMID: 23293117 DOI: 10.1093/annonc/mds635] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Penile cancer (PC) is a rare cancer in western countries, but is more common in parts of the developing world. Due to its rarity and the consequent lack of randomized trials, current therapy is based on retrospective studies and small prospective trials. Design Studies of PC therapy were searched in PubMed and abstracts at major conferences. Results PC is generally an aggressive malignancy characterized by early locoregional lymph node (LN) spread and later metastases in distant sites. Given the strong predictive value of LN involvement for overall survival, evaluating regional LNs is critical. Advanced LN involvement is increasingly being treated with multimodality therapy incorporating chemotherapy and/or radiation. A single superior cisplatin-based regimen has not been defined. Further advances may occur with a better collaboration on an international scale and comprehensive understanding of tumor biology. To this end, the preventive role of circumcision and understanding of the oncogenic roles of Human Papilloma Virus-16, and smoking may yield advances. Preliminary data suggest a role for agents targeting epidermal growth factor receptor and angiogenesis. Conclusion Advances in therapy for PC will require efficient trial designs, synergistic collaboration, incentives to industry and the efforts of patient advocacy groups and venture philanthropists.
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Affiliation(s)
- G Sonpavde
- Department of Medicine, Section of Medical Oncology, UAB Comprehensive Cancer Center, Birmingham
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35
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Gunia S, Burger M, Hakenberg OW, May D, Koch S, Jain A, Birnkammer K, Wieland WF, Otto W, Hofstädter F, Fritsche HM, Denzinger S, Gilfrich C, Brookman-May S, May M. Inherent Grading Characteristics of Individual Pathologists Contribute to Clinically and Prognostically Relevant Interobserver Discordance Concerning Broders' Grading of Penile Squamous Cell Carcinomas. Urol Int 2013; 90:207-13. [DOI: 10.1159/000342639] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 07/27/2012] [Indexed: 11/19/2022]
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Gunia S, Koch S, May M. Is CDX2 immunostaining useful for delineating anorectal from penile/vulvar squamous cancer in the setting of squamous cell carcinoma with clinically unknown primary site presenting with histologically confirmed inguinal lymph node metastasis? J Clin Pathol 2012; 66:109-12. [PMID: 23105122 DOI: 10.1136/jclinpath-2012-201138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS Penile, vulvar and anal squamous cell carcinomas (SCCs) share histomorphological overlap and are prone to lymphatic dissemination into inguinal nodes. Anal SCCs might derive from the anorectal zone (ARZ), anal transitional zone, squamous zone or from perianal skin. These anatomically distinct zones differ in terms of their embryological development. We sought to investigate the role of caudal-related homeobox 2 (CDX2), a homeobox gene implicated in the development and anterior/posterior pattern specification from duodenum to rectum including the ARZ, in terms of narrowing the possible sites of origin to be considered in the setting of SCC with unknown primary presenting with histologically confirmed inguinal lymph node metastasis. METHODS By immunohistochemistry (IHC) employing a panel of antibodies directed against CK5/6, CK7, CK20, p63, p16, CEA and CDX2, we compared 89 penile, 11 vulvar and eight anal SCCs with respect to their staining profiles. Moreover, anal SCCs were subjected to in situ hybridisation (ISH) for high-risk human papillomavirus (HPV) subtypes. RESULTS By IHC, CDX2 expression was observed in 2/8 anal SCCs (25%) while being absent from all penile and vulvar SCCs examined. High-risk HPV subtypes were detected by ISH in all anal SCCs examined, which were uniformly p16-positive by IHC. CONCLUSIONS CDX2 might be valuable in terms of narrowing the possible sites of origin to be considered in the setting of SCC with unknown primary presenting with inguinal lymph node metastasis. However, despite its favourable specificity, the diagnostic benefit achieved by this observation is limited by the low sensitivity.
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Affiliation(s)
- Sven Gunia
- Department of Pathology, Institute of Pathology at the Johanniter Hospital Stendal, Stendal, Germany.
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Danos AM, Liao Y, Li X, Du W. Functional inactivation of Rb sensitizes cancer cells to TSC2 inactivation induced cell death. Cancer Lett 2012; 328:36-43. [PMID: 23022476 DOI: 10.1016/j.canlet.2012.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 09/18/2012] [Accepted: 09/19/2012] [Indexed: 11/16/2022]
Abstract
We showed previously that inactivation of TSC2 induces death in cancer cells lacking the Retinoblastoma (Rb) tumor suppressor under stress conditions, suggesting that inactivation of TSC2 can potentially be used as an approach to specifically kill cancers that have lost WT Rb. As Rb is often inactivated in cancers by overexpression of cyclin D1, loss of p16(ink4a) cdk inhibitor, or expression of viral oncoproteins, it will be interesting to determine if such functional inactivation of Rb would similarly sensitize cancer cells to TSC2 inactivation induced cell death. In addition, many cancers lack functional Pten, resulting in increased PI3K/Akt signaling that has been shown to modulate E2F-induced cell death. Therefore it will be interesting to test whether loss of Pten will affect TSC2 inactivation induced killing of Rb mutant cancer cells. Here, we show that overexpression of Cyclin D1 or the viral oncogene E1a sensitizes cancer cells to TSC2 knockdown induced cell death and growth inhibition. On the other hand, knockdown of p16(ink4a) sensitizes cancer cells to TSC2 knockdown induced cell death in a manner that is likely dependant on serum induction of Cyclin D1 to inactivate the Rb function. Additionally, we demonstrate that loss of Pten does not interfere with TSC2 knockdown induced cell death in Rb mutant cancer cells. Together, these results suggest that TSC2 is potentially a useful target for a large spectrum of cancer types with an inactivated Rb pathway.
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Affiliation(s)
- Arpad M Danos
- Ben May Department for Cancer Research, The University of Chicago, Chicago, IL 60637, United States
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