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Rawal SK, Khanna A, Singh A, Jindal T, Sk R, Kumar B, Taori R, Pratihar SK, Vasudeo V, Saurabh N, Ali M, Malla I, Adhikari K. Robot-Assisted Video Endoscopic Inguinal Lymph Node Dissection for Penile Cancer: An Indian Multicenter Experience. J Endourol 2024; 38:879-883. [PMID: 38661519 DOI: 10.1089/end.2023.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Objective: To report outcomes of multicenter series of penile cancer patients undergoing robot-assisted video endoscopic inguinal lymph node dissection (RA-VEIL). Materials and Methods: In this retrospective analysis from 3 tertiary care centers in India, consecutive intermediate-/high-risk carcinoma penis (CaP) patients with nonpalpable inguinal lymphadenopathy and/or nonbulky (<3 cm) mobile inguinal lymphadenopathy undergoing RA-VEIL were included. Patients with matted/bulky (>3 cm) and fixed lymphadenopathy were excluded. Demographic, clinical, and intraoperative data were recorded. Perioperative complications were graded by the Clavien-Dindo classification (CDC). The International Society of Lymphology (ISL) {0-III} grading was used for the assessment of lymphedema. Incidence and pattern of recurrences were assessed on follow-up. Results: From January 1, 2011, to September 30, 2023, 115 patients (230 groins) underwent bilateral RA-VEIL for CaP. The median age of the cohort was 60 (50-69) years. Clinically palpable (either unilateral or bilateral) inguinal lymphadenopathy was seen in 54 patients (47%). The "per groin" median operative time was 120 (100-140) minutes with median lymph node yield of 12 (9-16). No complications were recorded in 87.8% groins operated, with major complications (CDC 3) seen in 2.6% groins. At a median follow-up of 13.5 months, 13 patients had documented recurrences and there were 10 cancer-related deaths. No port-site recurrences were observed. No/minimal lymphedema (ISL 0/I) was seen in 94% legs. Conclusion: RA-VEIL demonstrates safety and oncologic efficacy in penile cancer patients presenting with clinically nonpalpable and/or nonbulky inguinal lymphadenopathy, with favorable functional outcomes.
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Affiliation(s)
- Sudhir K Rawal
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ashish Khanna
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Amitabh Singh
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Tarun Jindal
- Department of Uro-Oncology and Robotic Surgery, Apollo Multispecialty Hospitals, Kolkata, West Bengal, India
| | - Raghunath Sk
- Department of Uro-Oncology and Robotic Surgery, HCG Cancer Hospital, Bengaluru, Karnataka, India
| | - Bhuvan Kumar
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ravi Taori
- Department of Uro-Oncology and Robotic Surgery, HCG Cancer Hospital, Bengaluru, Karnataka, India
| | - Sarbartha K Pratihar
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vivek Vasudeo
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Nikhil Saurabh
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mujahid Ali
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ishan Malla
- Department of Uro-Oncology and Robotic Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kinju Adhikari
- Department of Uro-Oncology and Robotic Surgery, HCG Cancer Hospital, Bengaluru, Karnataka, India
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O'Connell KA, Thomas JL, Murad F, Zhou G, Sonpavde GP, Mossanen M, Clinton TN, Ji-Xu A, Spiess PE, Rossi AM, Schmults CD. Factors predictive of recurrence, metastasis and death in node-negative penile squamous cell carcinoma: A retrospective multicentre cohort study. J Eur Acad Dermatol Venereol 2024. [PMID: 38842227 DOI: 10.1111/jdv.20093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Penile squamous cell carcinoma (PSCC) carries significant morbidity and mortality. Literature is limited regarding prognostic factors, especially prognostic factors for development of metastasis. OBJECTIVES To identify independent prognostic factors associated with poor outcomes, defined as local recurrence (LR), metastasis and disease-specific death (DSD) in clinically node-negative PSCC undergoing local therapy. METHODS Thirty-two-year Retrospective Multicenter Cohort Study of 265 patients with histologically diagnosed PSCC at three tertiary care centres. Predictive models based on patient or tumour characteristics were developed. RESULTS Local recurrence occurred in 56 patients, metastasis in 52 patients and DSD in 40 patients. In multivariable models, the following five factors were independent prognostic factors based on subhazard ratio (SHR): history of balanitis (LR SHR: 2.3; 95% CI 1.2-4.2), poor differentiation (metastasis SHR 1.9; 95% CI 1.0-3.6), invasion into the corpora (metastasis SHR: 3.0; 95% CI 1.5-5.8 and DSD SHR: 4.5; 95% CI 1.7-12.1), perineural invasion (PNI) (metastasis SHR: 2.8; 95% CI 1.4-5.5 and DSD SHR: 3.5; 95% CI, 1.6-7.8) and a history of phimosis (DSD SHR: 2.5; 95% CI 1.2-5.3). The 5-year cumulative incidence of metastasis was higher for tumours with PNI [cumulative incidence function (CIF) = 55%, 95% CI 38-75 vs. CIF 15%, 95% CI 11-22], corporal invasion (CIF: 35%, 95% CI 26-47 vs. 12%, 95% CI 7-19) and poorly differentiated tumours (CIF = 46%, 95% CI 31-64 vs. CIF 15%, 95% CI 11-22). CONCLUSIONS History of balanitis, history of phimosis, PNI, corporal invasion and poor differentiation are independent risk factors associated with poor outcomes. Since poor differentiation and PNI currently constitute only T1b disease, prognostic staging can likely be improved.
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Affiliation(s)
- Katie A O'Connell
- Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacob L Thomas
- Division of Dermatology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Weill Cornell Medical College, New York City, New York, USA
| | - Fadi Murad
- Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy N Clinton
- Division of Urology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio Ji-Xu
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | | | - Anthony M Rossi
- Division of Dermatology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Weill Cornell Medical College, New York City, New York, USA
| | - Chrysalyne D Schmults
- Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Mumba C, Muhimbe Z, Mapulanga V, Kawimbe M, Mutale K, Hamasuku A, Musumali J, Mwale NK, Ngalamika O. The effects of HIV and oncogenic human papillomavirus on the tumor immune microenvironment of penile squamous cell carcinoma. PLoS One 2024; 19:e0300729. [PMID: 38691575 PMCID: PMC11062539 DOI: 10.1371/journal.pone.0300729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/02/2024] [Indexed: 05/03/2024] Open
Abstract
Penile squamous cell carcinoma (PSCC) occurs more frequently in some developing countries compared to developed countries. Infection with HIV and/or high-risk human papillomavirus (hrHPV) are risk factors for penile cancer development. The tumor microenvironment of PSCC may predict prognosis and may inform on the best targets for immunotherapy. We evaluated the immune microenvironment of penile tumors histologically, and determined whether and/or how HIV and/or hrHPV infections affect this tumor microenvironment. We conducted a prospective analytical cross-sectional study in which penile cancer tumors from 35 patients presenting at the University Teaching Hospital in Lusaka, Zambia were histologically staged and assessed for presence of tumor infiltrating immune cells and expression of immune checkpoints. Immunohistochemistry was used to evaluate immune checkpoints and infiltrating immune cells, while multiplex real-time polymerase chain reaction was used for hrHPV genotyping. The median age of all participants was 55 years. About 24% had advanced histological stage, 83% were HIV+, and 63% had hrHPV detected in their tumors using multiplex real-time polymerase chain reaction. PDL1 expression was significantly higher in HIV- participants than HIV+ participants (p = 0.02). Tumors with multiple hrHPV infections had a significantly higher number of cells expressing TIM3 than those with one hrHPV (p = 0.04). High grade tumors had a significantly higher infiltrate of FoxP3+ cells (p = 0.02), CD68+ cells (p = 0.01), CD163+ cells (p = 0.01), LAG3+ cells (p = 0.01), PD1+ cells (p = 0.01) and TIM3+ cells (p = 0.03) when compared with low grade tumours. There was significant moderate to strong positive correlation of cells expressing PD1 and LAG3 (⍴ = 0.69; p = 0.0001), PD1 and TIM3 (⍴ = 0.49; p = 0.017) and TIM3 and LAG3 PDL1 (⍴ = 0.61; p = 0.001). In conclusion, the tumor microenvironment of penile squamous cell carcinoma seems to be affected by both HIV and HPV infections. TIM3 appears to be a potential therapeutic target in PSCC patients with hrHPV infections.
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Affiliation(s)
- Chibamba Mumba
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Zoran Muhimbe
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Victor Mapulanga
- Department of Surgery, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Musonda Kawimbe
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Keagan Mutale
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Anglin Hamasuku
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Jane Musumali
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Nicholas K Mwale
- Department of Physiological Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Owen Ngalamika
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
- Dermatology and Venerology Division, School of Medicine, University of Zambia, Lusaka, Zambia
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Zhou XL. Long-term follow-up of comparative study of open and endoscopic lymphadenectomy in patients with penile carcinoma. Surg Endosc 2024; 38:179-185. [PMID: 37950029 PMCID: PMC10776462 DOI: 10.1007/s00464-023-10542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Penile carcinoma is an uncommon cancer that develops in the penis tissue. The standard surgical method to manage regional lymph nodes after local excision is radical inguinal lymphadenectomy, but it has a high rate of complications. The objective of this retrospective study was to compare the long-term outcomes of endoscopic inguinal lymphadenectomy and open inguinal lymphadenectomy in patients with penile carcinoma. METHODS The study included patients diagnosed with penile carcinoma who underwent open inguinal lymphadenectomy (n = 23) or endoscopic inguinal lymphadenectomy (n = 27) at a single hospital between January 2013 and January 2021. Operation time, blood loss, drainage, hospital stay, postoperative complications, and survival rates were assessed and compared between the two groups. RESULTS The two groups were comparable in terms of age, tumor size and stage, inguinal lymph nodes, and follow-up. The endoscopic group had significantly lower blood loss (27.1 ± 1.5 ml vs 55.0 ± 2.7 ml, P < 0.05), shorter drainage time and hospital stay (4.7 ± 1.1 days vs 8.1 ± 2.2 days, and 13.4 ± 1.0 days vs 19 ± 2.0 days, respectively, P < 0.05), and longer operation time compared to the open group (82.2 ± 4.3 min in endoscopic group vs 53.1 ± 2.2 min in open group, P < 0.05). There were significant differences in the incidence of incisional infection, necrosis, and lymphorrhagia in both groups (4 vs 0, 4 vs 0, and 2 vs 0, respectively, P < 0.05). The inguinal lymph node harvested was comparable between the two groups. The mean follow-up time was similar for both groups (60.4 ± 7.7 m vs 59.8 ± 7.3 m), and the recurrence mortality rates were not significantly different. CONCLUSIONS The study shows that both open and endoscopic methods work well for controlling penile carcinoma in the long term. But the endoscopic approach is better because it has fewer severe complications. So, the choice of surgery method might depend on factors like the surgeon's experience, what they like, and what resources are available.
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Affiliation(s)
- Xue-Lu Zhou
- Department of Surgery, Chashan Hospital of Guangdong Medical University, 92 Caihong Road, Chashan Town, Dongguan, 523127, Guangdong, People's Republic of China.
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Campos MAG, Teixeira AAL, Calixto JDRR, Larges JS, Pinho JD, Silva GEB. Predictive histopathological factors of nodal metastasis in penile cancer. Int Braz J Urol 2023; 49:628-636. [PMID: 37351908 PMCID: PMC10482464 DOI: 10.1590/s1677-5538.ibju.2022.0640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Marcos Adriano Garcia Campos
- Universidade Estadual PaulistaFaculdade de MedicinaBotucatuSPBrasilFaculdade de Medicina da Universidade Estadual Paulista - Unesp, Botucatu, SP, Brasil
| | - Antonio Augusto Lima Teixeira
- Hospital Universitário Presidente DutraLaboratório de Imunofluorescência e Microscopia EletrônicaSão LuísMABrasilLaboratório de Imunofluorescência e Microscopia Eletrônica, Hospital Universitário Presidente Dutra, São Luís, MA, Brasil
- Universidade de São PauloDepartamento de GenéticaRibeirão PretoSPBrasilDepartamento de Genética, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - José de Ribamar Rodrigues Calixto
- Universidade Federal do MaranhãoDepartamento de Medicina IISão LuísMABrasilDepartamento de Medicina II, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - Joyce Santos Larges
- Hospital Universitário Presidente DutraLaboratório de Imunofluorescência e Microscopia EletrônicaSão LuísMABrasilLaboratório de Imunofluorescência e Microscopia Eletrônica, Hospital Universitário Presidente Dutra, São Luís, MA, Brasil
| | - Jaqueline Diniz Pinho
- Hospital Universitário Presidente DutraLaboratório de Imunofluorescência e Microscopia EletrônicaSão LuísMABrasilLaboratório de Imunofluorescência e Microscopia Eletrônica, Hospital Universitário Presidente Dutra, São Luís, MA, Brasil
- Universidade Estadual do MaranhãoZé DocaMABrasilUniversidade Estadual do Maranhão, Zé Doca, MA, Brasil
| | - Gyl Eanes Barros Silva
- Hospital Universitário Presidente DutraLaboratório de Imunofluorescência e Microscopia EletrônicaSão LuísMABrasilLaboratório de Imunofluorescência e Microscopia Eletrônica, Hospital Universitário Presidente Dutra, São Luís, MA, Brasil
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Kakoti S, Sureka SK, Pathak A, Shah US, Mishra N, Puneeth Kumar KM, Srivastava A, Singh UP. Comparing T2-T3 staging of penile cancer according to the American Joint Committee on cancer 8 th edition with two modified staging systems in predicting survival outcome: A single-center experience. Indian J Urol 2023; 39:53-57. [PMID: 36824107 PMCID: PMC9942220 DOI: 10.4103/iju.iju_162_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/11/2022] [Accepted: 12/15/2022] [Indexed: 02/25/2023] Open
Abstract
Introduction Penile cancer is a rare malignancy of the genitourinary tract. We aimed to validate the recent changes in the T2 and T3 stages of penile cancer in the American Joint Committee on Cancer (AJCC) 8th edition and to compare its predictive ability with two other modified staging systems for survival outcomes. Methods This is a retrospective study of patients diagnosed with penile cancer from June 2015 to March 2020. The AJCC 8th edition and two other newly proposed systems by Li et al. and Sali et al. were used for staging the tumor. All variables were categorized and correlated with lymph node (LN) metastases and overall survival (OS). Results Fifty-four patients were eligible for this study. The mean age was 58 years (range 46-72 years). The tumor stage (P = 0.016), clinical LN stage (P = 0.001), the involvement of the spongiosa (P = 0.015) and the cavernosa (P = 0.002), lymphovascular invasion (LVI) (P = 0.000), and PNI (P = 0.021) were found to be the significant predictors of LN metastases. When the 5 year OS was compared between the T2 and T3 stages of the AJCC 8th edition, Li staging and the Sali staging systems, it was 91% and 50.1% (P = 0.001), 97.5% and 10.3% (P = 0.000), 94.4% and 14.7% (P = 0.000), respectively. The presence of LVI (P = 0.001) was the most significant independent predictor of OS. Conclusions The recent changes in the AJCC 8th edition pertaining to the T2-T3 stage are relevant, although the other two newly proposed staging systems were more precise in predicting the survival outcomes.
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Affiliation(s)
- Shitangsu Kakoti
- Department of Urology, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhishek Pathak
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Utsav Shailesh Shah
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Navneet Mishra
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - K. M. Puneeth Kumar
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Dorofte L, Grélaud D, Fiorentino M, Giunchi F, Ricci C, Franceschini T, Riefolo M, Davidsson S, Carlsson J, Lillsunde Larsson G, Karlsson MG. Low level of interobserver concordance in assessing histological subtype and tumor grade in patients with penile cancer may impair patient care. Virchows Arch 2021; 480:879-886. [PMID: 34889977 PMCID: PMC9023398 DOI: 10.1007/s00428-021-03249-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
Differentiation between penile squamous cell carcinoma patients who can benefit from limited organ-sparing surgery and those at significant risk of lymph node metastasis is based on histopathological prognostic factors including histological grade and tumor histological subtype. We examined levels of interobserver and intraobserver agreement in assessment of histological subtype and grade in 207 patients with penile squamous cell carcinoma. The cases were assessed by seven pathologists from three hospitals located in Sweden and Italy. There was poor to moderate concordance in assessing both histological subtype and grade, with Fleiss kappas of 0.25 (range: 0.02-0.48) and 0.23 (range: 0.07-0.55), respectively. When choosing HPV-associated and non-HPV-associated subtypes, interobserver concordance ranged from poor to good, with a Fleiss kappa value of 0.36 (range: 0.02-0.79). A re-review of the slides by two of the pathologists showed very good intraobserver concordance in assessing histological grade and subtype, with Cohen's kappa values of 0.94 and 0.91 for grade and 0.95 and 0.84 for subtype. Low interobserver concordance could lead to undertreatment and overtreatment of many patients with penile cancer, and brings into question the utility of tumor histological subtype and tumor grade in determining patient treatment in pT1 tumors.
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Affiliation(s)
- Luiza Dorofte
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Diane Grélaud
- Department of Clinical Genetics and Pathology, Skåne University Hospital and Regional Laboratories, Malmö, Sweden
| | - Michelangelo Fiorentino
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Giunchi
- Pathology, Istituto Di Ricovero E Cure a Carattere Scientifico, Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Costantino Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Pathology Unit, Maggiore Hospital, AUSL Bologna, Bologna, Italy
| | | | - Mattia Riefolo
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Pathology Unit, Maggiore Hospital, AUSL Bologna, Bologna, Italy
| | - Sabina Davidsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jessica Carlsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriella Lillsunde Larsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mats G Karlsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Malik K, Chandrasekaran D, Kathiresan N, Raja A. Factors Predicting Nodal Metastasis in Penile Cancer: Analysis from a Tertiary Center. Urol Int 2021; 106:716-721. [PMID: 34818663 DOI: 10.1159/000519918] [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: 05/09/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lymph node metastasis is an important prognostic marker in penile cancer. Identification of occult metastasis is by lymphadenectomy based on the histological features of primary tumor; however, this leads to unnecessary surgical morbidity in node negative patients. METHODS A retrospective analysis of all surgically treated penile cancer patients managed at our institute from January 2011 to March 2014 was performed. Patient characteristics, histological factors, and lymph node involvement were identified. Logistic regression analysis was used to compute odds ratio (OR) in univariate and multivariate analysis. RESULTS Ninety seven patients underwent surgical management at our institute during the abovementioned period. Grade III tumor, presence of lymphovascular invasion, tumor thickness >10 mm, perineural invasion (PNI) and Ki67 >50% were significantly associated with nodal metastasis. On multivariate analysis, only presence of PNI was found to be significant (OR: 6.82) (95% confidence interval: 1.72-27.03) (p = 0.006). CONCLUSION PNI is a strong independent predictor of occult lymph node metastasis in penile cancers. Its inclusion in stratification of clinically node negative patients will identify high-risk patients who will benefit from prophylactic lymphadenectomy.
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Affiliation(s)
- Kanuj Malik
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India,
| | - Deepak Chandrasekaran
- Department of Surgical Oncology, Velammal Medical College Hospital and Research Institute, Madurai, India
| | | | - Anand Raja
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
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Azevedo RA, Roxo AC, Alvares SHB, Baptista DP, Favorito LA. Use of flaps in inguinal lymphadenectomy in metastatic penile cancer. Int Braz J Urol 2021; 47:1108-1119. [PMID: 34115457 PMCID: PMC8486440 DOI: 10.1590/s1677-5538.ibju.2021.99.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/20/2021] [Indexed: 04/04/2024] Open
Abstract
PURPOSE Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. MATERIAL AND METHODS We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. RESULTS A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. CONCLUSIONS The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.
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Affiliation(s)
- Roberta Alvares Azevedo
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
- Universidade do Estado do Rio de JaneiroDepartamento de Cirurgia GeralRio de JaneiroRJBrasilDepartamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Ana Claudia Roxo
- Universidade do Estado do Rio de JaneiroDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Departamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Silvia Helena Baima Alvares
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Daniel Pereira Baptista
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
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Müller T, Demes M, Lehn A, Köllermann J, Vallo S, Wild PJ, Winkelmann R. The peri- and intratumoral immune cell infiltrate and PD-L1 status in invasive squamous cell carcinomas of the penis. Clin Transl Oncol 2021; 24:331-341. [PMID: 34449004 PMCID: PMC8794908 DOI: 10.1007/s12094-021-02694-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/08/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Penile carcinomas are rare tumors throughout Europe. Therefore, little attention is drawn to this disease. That makes it important to study tumor-associated key metrics and relate these to known data on penile neoplasias. MATERIALS AND METHODS A cohort of 60 well-defined penile invasive carcinomas with known human papillomavirus (HPV) infection status was investigated. Data on tumor type, grading and staging were recorded. Additionally, data on the peri- and intratumoral immune cell infiltrate in a semiquanititave manner applying an HE stain were assessed. RESULTS Our study showed a significant correlation of immune cell infiltrate and pT stage with overall survival. Therefore, in a subset of tumors, PD-L1 staining was applied. For tumor proportion score (TPS), 26 of 30 samples (87%) were scored >0%. For the immune cell score (IC), 28 of 30 samples (93%) were defined as >0% and for CPS, 29 of 30 samples (97%) scored >0. PD-L1 expression was not associated with overall survival. CONCLUSION PD-L1 is expressed in penile carcinomas, providing a rationale for targeted therapy with checkpoint inhibitors. We were able to show that immune reaction appears to be prognostically relevant. These data enhance the need for further studies on the immune cell infiltrate in penile neoplasias and show that PD-L1 expression is existent in our cohort, which may be a potential target for checkpoint inhibitor therapy.
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Affiliation(s)
- T Müller
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - M Demes
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Lehn
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | - J Köllermann
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - S Vallo
- Institute of Virology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P J Wild
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany.,Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany
| | - R Winkelmann
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany.
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11
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What Is New in the Pathologic Staging of Penile Carcinoma in the 8th Edition of AJCC TNM Model: Rationale for Changes With Practical Stage-by-stage Category Diagnostic Considerations. Adv Anat Pathol 2021; 28:209-227. [PMID: 34050061 DOI: 10.1097/pap.0000000000000297] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For >50 years the tumor, node, metastasis (TNM) classification model of malignant tumors has been the main resource for clinicians, pathologists, radiologists and public health professionals ensuring a homogeneous classification and patients' management based on common staging and prognosis factors. Penile cancer was first included for staging in the third edition of the TNM classification with several changes in the last version, the 8th edition of the AJCC TNM Manual, in 2017. Some changes in the pT category were done due to recent knowledge regarding the prognostic importance of anatomical level of invasion, vascular and perineural invasion and tumor grading. These changes must be interpreted in the light of a required understanding of the complex anatomy of penile compartments especially their histological boundaries, the morphological differences of each level needed for the correct classification, the heterogeneity of penile squamous cell carcinomas and an adequate criticism of the current model used by the TNM system. We present here a series of stage-by-stage category diagnostic considerations based on the clinical experience acummulated over the years of applying the different TNM staging classifications in our large clinical practice. Some discrepancies will need well-designed prospective studies for im4proving the actual classification.
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Vale L, Fernandes B, Rodrigues V, Dinis P, Silva C, Antunes-Lopes T. Prognostic Factors in Penile Cancer: Should We Avoid Inguinal Lymph Node Staging? Urol Int 2021; 105:799-803. [PMID: 33601381 DOI: 10.1159/000512377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Penile cancer (PC) is a rare neoplasm, mostly in developed countries. Herewith, we evaluate the main prognostic factors of patients with PC undergoing surgery. METHODS This is a retrospective analysis of prognostic factors of overall survival in 65 patients with PC treated at a tertiary referral center over the last 15 years (2004-2018). RESULTS Almost half (48%) of the patients were diagnosed at an advanced local stage pT3/4. Thirty-eight (58%) patients underwent inguinal lymphadenectomy, and 25 (66%) were negative for lymph node (LN) invasion. Overall survival was 80% at a median follow-up of 31 months. In the multivariate analysis, the main factors of poor prognosis were nodal staging (pN) (p = 0.008) and perineural invasion (p = 0.023). The presence of LN metastasis and perineural invasion in the primary tumor increased the risk of death by 29 (hazard ratio 29.0, 95% confidence interval 2.4-354.2) and 13 (hazard ratio 12.7, 95% confidence interval 1.4-112.0) times, respectively. DISCUSSION/CONCLUSION Late diagnosis of PC has a negative impact on overall survival, as nodal invasion correlates with survival. Despite the high number of negative inguinal lymphadenectomy, we continue to advocate aggressive surgical treatment of this disease due to the poor prognosis associated with LN metastasis.
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Affiliation(s)
- Luís Vale
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal, .,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal,
| | | | - Vasco Rodrigues
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Paulo Dinis
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine of Porto, University of Porto, Porto, Portugal
| | - Carlos Silva
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine of Porto, University of Porto, Porto, Portugal
| | - Tiago Antunes-Lopes
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine of Porto, University of Porto, Porto, Portugal
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Sanchez DF, Fernandez-Nestosa MJ, Cañete-Portillo S, Cubilla AL. Evolving insights into penile cancer pathology and the eighth edition of the AJCC TNM staging system. Urol Oncol 2020; 40:215-222. [PMID: 33008752 DOI: 10.1016/j.urolonc.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/19/2020] [Accepted: 09/13/2020] [Indexed: 01/30/2023]
Abstract
The majority of penile malignant tumors are squamous cell carcinomas. They are pathologically defined as epithelial neoplasms originating in the squamous cells of the inner mucosal lining of the glans, coronal sulcus or foreskin. Tumor location and site of origin is preferentially in glans (70%) followed by foreskin (25%) and coronal sulcus (5%). Despite the variable geographic distribution, pathological features of penile carcinomas in areas of high- and low-risk are similar. Penile tumors are morphologically heterogeneous. A major advance, based on biological, etiological and prognostic factors, is the 2016 WHO classification separating epithelial penile neoplasia, precancerous and invasive, in non-HPV and HPV-related.
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Affiliation(s)
- Diego F Sanchez
- Instituto de Patología e Investigación, Asunción, Paraguay; School of Medicine, National University of Asuncion, San Lorenzo, Paraguay
| | - Maria Jose Fernandez-Nestosa
- Instituto de Patología e Investigación, Asunción, Paraguay; Polytechnic School, National University of Asunción, San Lorenzo, Paraguay
| | | | - Antonio L Cubilla
- Instituto de Patología e Investigación, Asunción, Paraguay; School of Medicine, National University of Asuncion, San Lorenzo, Paraguay.
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Wang H, Zhu L, Li G, Zuo M, Ma X, Wang J. Perfusion parameters of intravoxel incoherent motion based on tumor edge region of interest in cervical cancer: evaluation of differentiation and correlation with dynamic contrast-enhanced MRI. Acta Radiol 2020; 61:1087-1095. [PMID: 31825761 DOI: 10.1177/0284185119890086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) is a functional magnetic resonance imaging (MRI) sequence. PURPOSE To evaluate the value of perfusion parameters derived from IVIM-DWI based on tumor edge region of interest (ROI) in differentiation in cervical cancer and investigate the relationship between IVIM and dynamic contrast-enhanced MRI (DCE-MRI). MATERIAL AND METHODS Thirty-three patients with pathologically diagnosed squamous cell carcinoma who underwent IVIM-DWI (nine b-values: 1-1000 s/mm2) and DCE-MRI were retrospectively assessed in this study. Parameters of IVIM (D, f, D*, fD*) and quantitative parameters of DCE-MRI (Ktrans, Kep, Ve) were derived using tumor edge ROI. Mann-Whitney U test was used to compare parameters between pathological grades and receiver operating characteristic (ROC) curves were used. Pearson's correlation coefficient (r) evaluated the correlation between perfusion parameters derived from IVIM and DCE-MRI. RESULTS The poorly differentiated group showed the significantly lower D value and the higher f, Ktrans and Kep values than the well-to-moderately differentiated group (P < 0.05). ROC curves indicated that f < 26%, Ktrans <0.38/min, and Kep <1.62/min could differentiate the poorly differentiated group from the well-to-moderately differentiated group (AUC 0.753-0.808). Significantly positive correlations were found between f and Ktrans (r = 0.422, P = 0.014) and between fD* and Ktrans (r = 0.448, P = 0.009). CONCLUSION Perfusion parameters derived from IVIM based on tumor edge ROI may offer additional value in differentiation in cervical cancer, and the IVIM perfusion parameters showed moderate positive correlations with quantitative perfusion parameters from DCE-MRI, while f and fD* showed promising significance.
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Affiliation(s)
- Hongyan Wang
- Department of Radiology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, PR China
| | - Lixia Zhu
- Department of Obstetrics and Gynecology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, PR China
| | - Guohua Li
- Department of Radiology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, PR China
| | - Menzhe Zuo
- Department of Radiology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, PR China
| | - Xi Ma
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, PR China
| | - Jianliang Wang
- Department of Radiology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, PR China
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Krishna S, Shanbhogue K, Schieda N, Morbeck F, Hadas B, Kulkarni G, McInnes MD, Baroni RH. Role of MRI in Staging of Penile Cancer. J Magn Reson Imaging 2020; 51:1612-1629. [PMID: 31976600 DOI: 10.1002/jmri.27060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
Penile cancer is one of the male-specific cancers. Accurate pretreatment staging is crucial due to a plethora of treatment options currently available. The 8th edition American Joint Committee on Cancer-Tumor Node and Metastasis (AJCC-TNM) revised the staging for penile cancers, with invasion of corpora cavernosa upstaged from T2 to T3 and invasion of urethra downstaged from T3 to being not separately relevant. With this revision, MRI is more relevant in local staging because MRI is accurate in identifying invasion of corpora cavernosa, while the accuracy is lower for detection of urethral involvement. The recent European Urology Association (EAU) guidelines recommend MRI to exclude invasion of the corpora cavernosa, especially if penis preservation is planned. Identification of satellite lesions and measurement of residual-penile-length help in surgical planning. When nonsurgical treatment modalities of the primary tumor are being considered, accurate local staging helps in decision-making regarding upfront inguinal lymph node dissection as against surveillance. MRI helps in detection and extent of inguinal and pelvic lymphadenopathy and is superior to clinical palpation, which continues to be the current approach recommended by National Comprehensive Cancer Network (NCCN) treatment guidelines. MRI helps the detection of "bulky" lymph nodes that warrant neoadjuvant chemotherapy and potentially identify extranodal extension. However, tumor involvement in small lymph nodes and differentiation of reactive vs. malignant lymphadenopathy in large lymph nodes continue to be challenging and the utilization of alternative contrast agents (superparamagnetic iron oxide), positron emission tomography (PET)-MRI along with texture analysis is promising. In locally recurrent tumors, MRI is invaluable in identification of deep invasion, which forms the basis of treatment. Multiparametric MRI, especially diffusion-weighted-imaging, may allow for quantitative noninvasive assessment of tumor grade and histologic subtyping to avoid biopsy undersampling. Further research is required for incorporation of MRI with deep learning and artificial intelligence algorithms for effective staging in penile cancer. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2020;51:1612-1629.
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Affiliation(s)
- Satheesh Krishna
- Faculty of Medicine, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Krishna Shanbhogue
- Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Fernando Morbeck
- Department of Diagnostic Imaging, Sao Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Benhabib Hadas
- Faculty of Medicine, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Girish Kulkarni
- Departments of Surgery and Surgical Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Matthew D McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ronaldo Hueb Baroni
- Department of Diagnostic Imaging, Sao Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Challenging the prognostic impact of the new WHO and TNM classifications with special emphasis on HPV status in penile carcinoma. Virchows Arch 2019; 475:211-221. [DOI: 10.1007/s00428-019-02566-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
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Suárez-Bonnet A, Willis C, Pittaway R, Smith K, Mair T, Priestnall SL. Molecular carcinogenesis in equine penile cancer: A potential animal model for human penile cancer. Urol Oncol 2018; 36:532.e9-532.e18. [PMID: 30270026 DOI: 10.1016/j.urolonc.2018.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/19/2018] [Accepted: 09/03/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the expression of COX-2, E-cadherin, vimentin, 14-3-3σ, and Phosphatase and tensin homolog (PTEN) tumor-related proteins in equine penile papillomas (ePP) and squamous cell carcinomas (ePSCC), the occurrence of epithelial-mesenchymal transition (EMT) at the invasion front (IF) and compare our findings with current knowledge on human penile squamous cell carcinoma (hPSCC). MATERIAL AND METHODS We analyzed, by immunohistochemistry in 45 equine penile proliferative epithelial lesions, the expression of COX-2, E-cadherin, vimentin, 14-3-3σ, and PTEN using monoclonal antibodies. Tumors were histopathologically classified as well-differentiated or poorly differentiated using the IF grading scheme. Semiquantitative analysis was performed to determine down or up-regulation of the proteins and association with histopathological characteristics were statistically investigated using Mann-Whitney U test and/or Spearman's tests. RESULTS COX-2 was neo-expressed in 86.6% of the cases and expression progressively increased from ePP to ePSCC (P = 0.0003) and from well to poorly differentiated (P = 0.033). High COX-2 expression was associated with a high mitotic index (MI) (P = 0.026). In contrast to normal epidermis, ePSCC had very low E-cadherin expression in 64% of the cases (P = 0.0005). Vimentin was neo-expressed in 65% of poorly differentiated ePSCC at the IF indicating EMT. Cytoplasmic 14-3-3σ protein expression was reduced in 42% of the ePSCC and additionally, nuclear expression of 14-3-3σ in neoplastic keratinocytes and in the cytoplasm of stromal fibroblasts at the IF was features only found in ePSCC. PTEN protein showed a tendency to be decreased or lost in ePSCC. CONCLUSIONS Our study provides evidence of molecular abnormalities in ePSCC similar to those reported for human PSCC. The occurrence of EMT at the IF is a common event in ePSCC. Naturally occurring ePSCC could serve as a valuable preclinical animal model to explore upcoming therapeutic options for hPSCC.
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Affiliation(s)
- Alejandro Suárez-Bonnet
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK.
| | - Claire Willis
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - Rachel Pittaway
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - Ken Smith
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - Tim Mair
- Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent ME18 5GS, UK
| | - Simon L Priestnall
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
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Prognostic factors in patients with penile cancer after surgical management. World J Urol 2018; 36:435-440. [PMID: 29299663 DOI: 10.1007/s00345-017-2167-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/26/2017] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To examine the possible prognostic factors in patients with penile cancer after surgical management and to identify the independent predictive factors of the prognosis. MATERIALS AND METHODS Clinical data of 135 patients with penile cancer who underwent surgical management in two medical centers were collected. Follow-up data were available for 103 patients. Possible prognostic factors including patient's age; smoking or not; course of disease; phimosis or not; type of surgery; tumor stage; nodal stage; tumor grade and pathological lymph nodes metastasis were retrospectively analyzed by univariate and multivariate analyses with Cox regression. RESULTS Five-year cancer-specific survival (CSS) and 1-year CSS were 88.5 and 98.1%, respectively. Univariate Cox analysis revealed that nodal stage and pathological lymph nodes metastasis were significant prognostic factors. Multivariate Cox analysis revealed pathological lymph nodes metastasis was the independent predictive factor of the prognosis. CONCLUSION Pathological lymph nodes metastasis is the independent predictive factor worsening the prognosis in patients with penile cancer.
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Comparison of efficacy between brachytherapy and penectomy in patients with penile cancer: a meta-analysis. Oncotarget 2017; 8:100469-100477. [PMID: 29245993 PMCID: PMC5725035 DOI: 10.18632/oncotarget.18761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/10/2017] [Indexed: 11/25/2022] Open
Abstract
We conducted a meta-analysis to compare the efficacy of brachytherapy and penectomy in patients with penile cancer. We searched the published articles in the PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to March 20, 2017. Twenty-two studies entered the final analyses. We used five-year overall survival rate, five-year local control rate, disease-free progression and lymph node positive rate to assess the efficacy. The meta-analysis found that patients who received penectomy had higher five-year local control rate (85% vs 80%, odds ratio = 0.72, 95% confidence interval: 0.58–0.90), five-year disease-free progression rate (77% vs 72%, odds ratio = 0.77, 95% confidence interval: 0.63–0.93) and lymph node positive rates (24% vs 20%, odds ratio = 0.79, 95% confidence interval: 0.64–0.98) than brachytherapy. No significant difference was observed for two group in five-year overall survival rate (76% vs 74%, odds ratios = 1.11 with the 95% confidence interval: 0.91–1.36). Both of penectomy and brachytherapy can improve the survival status. Penectomy provided better control efficacy, and not improved the survival status compared with brachytherapy solely. However, further research was required because of retrospective nature and potential bias of the data.
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