P02-11THE PROGNOSTIC ROLE OF DETECTION AND GENOTYPING OF HPV IN PENILE CARCINOMA

02. Epidemiology and natural history
M.A.S. Carneiro 1, V.A. Saddi 2, J.C. Almeida Netto 1, S.H. Rabelo-Santos 1, E.D. Motta 3, L.A. Araújo 4, H.D.S.C. Paula 4, K.P.A. carvalho 4, J.E.P. ramos 5, A.A.P. De Paula 6.
1Institute of Tropical Pathology and Public Health of the Federal University of Goias, Brazil; PhD. (Brazil), 2Genetics Department of the Pontificius Catholic University of Goias, Brazil; PhD. (Brazil), 3-Pathology Department of Araujo Jorge Hospital from the Associaçao de Combate ao Cancer em Goias, Brazil; MD. (Brazil), 4.Institute of Tropical Pathology and Public Health of the Federal University of Goias, Brazil; PhD. (Brazil), 5Genetics Department of the Pontificius Catholic University of Goias, Brazil; PhD (Brazil), 6Onco-Urology Department of Araujo Jorge Hospital from the Associaçao de Combate ao Cancer em Goias, Brazil; MD, PhD. (Brazil)

Background / Objectives

A Penile carcinoma (PC) is a rare disease in North America and Europe, a frequent and a serious health problem in developing countries such as Brazil1-3.   More than 4600 cases of PC have been registered by the Brazilian National Cancer Institute in 20154 .The recurrence or persistence of the infection, including human papillomavirus (HPV), may lead or contribute to the development of penile carcinoma5,6. The prevalence of HPV changes according to the subtypes of squamous cell PC and is 30 to 50% 7. Although it can reach almost 100% in basaloid, in situ and verrucous penile carcinoma8. Objective:  Analyze the influence of the presence and detect the type of Human Papillomavirus (HPV) in groin metastasis and specific-cancer survival of patients with penile carcinoma, as well its association to histological variables.


Methods

This retrospective cohort study involved 113 patients with PC treated in the Uro-Oncology service of Hospital Araujo Jorge (HAJ), a unit of the Association Against Cancer in Goias, Brazil (ACCG), from January 2003 to November 2015. This study was approved by the Research Ethics Committee of HAJ.The paraffin blocks containing the cancerous tissue fragments were subjected to extraction of viral DNA using a commercial kit (Promega Corporation, USA), subsequently subjected to polymerase chain reaction testing with short PCR fragment (SPF PCR) primers to detect HPV DNA.. HPV genotyping was performed using INNO-LiPA.The HPV 16 and/or 18 presence and its association to other histological profiles were evaluated in penile carcinoma (PC) patients. Uni and multivariate analysis were performed to establish the role of histopathological and HPV on the risk of inguinal metastasis and cancer-specific survival of those patients.. 


Results

: One hundred and thirteen patients were enrolled, fourty seven detected with HPV (41.5%). Almost sixty percent of the cases harbored low grade squamous cell carcinoma (SCC). The most prevalent histological subtype was the usual SCC (69.9%), followed by warty SCC (13.3%). The high histological grade (p=0.02) and the presence of HPV18 (p=0.02) were independent prognosticators for specific cancer survival (SCS). Neither the presence of HPV nor the HPV genotype were associated to a higher risk of groin metastasis..


Conclusion

The findings suggest that HPV 18 is an independent factor of poor cancer-specific survival. The overall HPV prevalence (41.5%) and genotype 16 as the most prevalent (51%), followed by HPV18 (23.4%).The importance of HPV in PC is undeniable, although multi-institutional, prospective, colaborative studies concerning this issue are still necessary to better establish its’ prevalence and prognostic impact.  


References

1- DE PAULA, A. A. P.; NETTO, J. C. A.; DA CRUZ, A. D.;  FREITAS JÚNIOR, R. Penile squamous carcinoma: epidemiological, histopathological, viral influence and surgical considerations. Revista Brasileira de Cancerologia, v. 51, n. 3; p. 243-252, 2005.

2- BLEEKER, M. C.; HEIDEMAN, D. A.; SNIJDERS, P. J.; HORENBLAS, S.; DILLNER, J.; MEIJER, C. J. Penile cancer: epidemiology, pathogenesis and prevention. World journal of urology, v. 27, n. 2, p. 141-150, 2009

3- SPIESS P. E.; HORENBLAS, S.; PAGLIARO, L. C.; BIAGIOLI, M. C.; CROOK, J.; CLARK, P. E.; et al. Current concepts in penile cancer. Journal of the National Comprehensive Cancer Network, v.11, n. 5, p. 617-624, 2013.

4- INCA. Instituto Nacional de Câncer. Câncer de Pênis, 2016A. Disponível em:  http://www2.inca.gov.br/wps/wcm/connect/tiposdecancer/site/home/penis. Acesso em 31/03/2016, às 10:32.

5-DALING, J. R.; MADELEINE, M. M.; JOHNSON, L. G.; SCHWARTZ, S. M.; SHERA, K. A.; WURSCHER, M. A.; CARTER, J. J.; PORTER, P. L.; GALLOWAY, D. A.; MCDOUGALL, J. K.; KRIEGER, J. N. Penile cancer: importance of circumcision, human papillomavirus and smoking in situ and invasive disease. Int. J. Cancer, v. 116, p. 606-616, 2005.

6- STRATTON, K. L.; CULKIN, D. J. A Contemporary Review of HPV and Penile Cancer. Oncology Journal, v. 15, 2016.

MORRISON, B. F. Risk Factors and Prevalence of Penile Cancer. West Indian Med J, v. 63, n. 6, p. 559-560, 2014

8-MIRALLES-GURI, C; BRUNI, L.; CUBILLA, A. L.; CASTELLSAGUÉ, X.; BOSCH, F. X.; DE SANJOSÉ, S. Human papillomavirus prevalence and type distribution in penile carcinoma. J Clin Pathol., v. 62, n. 10, p. 870-878, 2009.