Human Papilloma Virus (HPV) status may impact treatment outcomes in patients with pre-cancerous penile lesions (an eUROGEN Study)
Shanks, Jonathan H
Parnham, Arie S
Lau, Maurice W
Sangar, Vijay K
AffiliationDepartments of Urology, The Christie NHS Foundation Trust, Manchester,
MetadataShow full item record
AbstractPenile intra-epithelial neoplasia (PeIN) is a known precursor for penile cancer. It may be undifferentiated or differentiated. The former is related to high-risk Human Papilloma Virus (HPV) and associated with p16 over-expression. Patients may present with red patches or lesions on the penis which on occasion may affect sexual activity.This study will assess associations between p16 status, patient parameters, treatment choice and outcomes. Data were collected on patients diagnosed with PeIN, who were referred to a single European Network, between 2008 and 2018. The following parameters were collected utilising patient records: demographics, smoking status, performance status, comorbidities, HPV/p16 status, lichen sclerosus (LS) status, treatment and clinical response. Log rank, Kaplan-Meier, Pearson Chi-Squared and Fishers Exact test were utilised to determine significance. One hundred thirty-seven patients were identified with PeIN and no invasive cancer. Staining for p16 was available in 91 patients and 74 patients were p16+. There were no significant differences in disease-free survival (DFS) for smoking status, performance status, comorbidities and lichen sclerosus, although patients with lichen sclerosus tended to recur sooner. Overall, p16+ patients showed significantly better DFS over p16- patients (n = 67; 10.4 vs 7.4 months; p = 0.023). In p16+ patients receiving treatment with imiquimod alone or with surgery, response rates were 100% vs 54% without imiquimod (n = 56; p = 0.017). In p16- patients receiving treatment with imiquimod alone or with surgery, response rates were 100% vs 56% without imiquimod (n = 17; p = 0.99). Overall 13.6% of patients progressed to cancer. The results indicate treatment combinations with immunotherapy tend to provide better responses despite p16 status. Patients with p16+ disease have a longer disease-free survival. Approximately 14% of patients progress to invasive disease. However, given the limitations in this study, further research is required to confirm these findings.
CitationAshley S, Shanks JH, Oliveira P, Lucky M, Parnham A, Lau M, et al. Human Papilloma Virus (HPV) status may impact treatment outcomes in patients with pre-cancerous penile lesions (an eUROGEN Study). Int J Impot Res. 2020.
JournalInternational Journal of Impotence Research
- Distinctive association of p16INK4a overexpression with penile intraepithelial neoplasia depicting warty and/or basaloid features: a study of 141 cases evaluating a new nomenclature.
- Authors: Chaux A, Pfannl R, Lloveras B, Alejo M, Clavero O, Lezcano C, Muñoz N, de Sanjosé S, Bosch X, Hernández-Pérez M, Velazquez EF, Cubilla AL
- Issue date: 2010 Mar
- Identification and genotyping of human papillomavirus in a Spanish cohort of penile squamous cell carcinomas: correlation with pathologic subtypes, p16(INK4a) expression, and prognosis.
- Authors: Ferrándiz-Pulido C, Masferrer E, de Torres I, Lloveras B, Hernandez-Losa J, Mojal S, Salvador C, Morote J, Ramon y Cajal S, Pujol RM, Garcia-Patos V, Toll A
- Issue date: 2013 Jan
- Continuous Spatial Sequences of Lichen Sclerosus, Penile Intraepithelial Neoplasia, and Invasive Carcinomas: A Study of 109 Cases.
- Authors: Cañete-Portillo S, Sanchez DF, Fernández-Nestosa MJ, Piris A, Zarza P, Oneto S, Gonzalez Stark L, Lezcano C, Ayala G, Rodriguez I, Hoang MP, Mihm MC, Cubilla AL
- Issue date: 2019 Aug
- Distinctive immunohistochemical profile of penile intraepithelial lesions: a study of 74 cases.
- Authors: Chaux A, Pfannl R, Rodríguez IM, Barreto JE, Velazquez EF, Lezcano C, Piris A, Netto GJ, Cubilla AL
- Issue date: 2011 Apr
- Two major pathways of penile carcinogenesis: HPV-induced penile cancers overexpress p16ink4a, HPV-negative cancers associated with dermatoses express p53, but lack p16ink4a overexpression.
- Authors: Mannweiler S, Sygulla S, Winter E, Regauer S
- Issue date: 2013 Jul