Data on the impact of human papillomavirus (HPV) infection status and outcomes for perioperative treatments for patients with lymph node-involved penile squamous-cell carcinoma (PSCC) are lacking.
To analyze the benefit from perioperative radiotherapy (RT) for PSCC according to HPV infection status.
In an international multicenter database of 1254 patients with PSCC who received inguinal lymph node dissection (ILND), 507 had suitable clinical information.
ILND, with or without chemotherapy or RT for involved lymph nodes.
Kaplan-Meier and restricted mean survival time (RMST) analyses for overall survival (OS) were performed for all patients and after propensity score-matching (PSM; n = 136), for which patient age, histology, type of penile surgical procedure, pathological tumor and nodal stage, ILND laterality, pelvic LND, and perioperative treatment were taken into account when assessing differences between HPV+ and HPV- patients. Finally, we looked at genomic alterations in PSCC using data from the Foundation Medicine database (n = 199) to characterize HPV+ PSCC.
Patients with HPV+ PSCC (n = 86; 17%) had lower clinical N stage (p < 0.001) and inguinal lymph node metastasis density (p < 0.001). Perioperative RT was delivered in 49 patients (9.7%), with the vast majority receiving adjuvant RT (n = 40). HPV+ patients had similar median OS (p = 0.1) but longer RMST than HPV- patients at different time points. Nevertheless, HPV+ patients treated with perioperative RT exhibited longer median OS (p = 0.015) and longer RMST compared to HPV- patients. In the PSM cohorts, HPV+ status remained significantly associated with longer OS after RT. The HPV- PSCC group had a higher frequency of TP53 mutations compared to HPV+ PSCC (75% vs 15%; p < 0.001). The results are limited by the retrospective nature of the data.
Perioperative RT was more effective in the HPV+ PSCC subgroup. Reasons for the enhanced radiosensitivity may be related to the lack of TP53 mutations.
We analyzed data from a large multicenter database for patients with penile cancer who had received inguinal lymph node dissection, with or without chemotherapy or radiotherapy. We found that for tumors positive for human papillomavirus (HPV), use of radiotherapy resulted in prolonged survival compared to HPV-negative tumors. On the basis of these results we are inspired to design studies on the use of radiotherapy in HPV-selected patients.
European urology oncology. 2020 Nov 13 [Epub ahead of print]
Marco Bandini, Jeffrey S Ross, Yao Zhu, Ding-Wei Ye, Antonio A Ornellas, Nick Watkin, Benjamin A Ayres, Oliver W Hakenberg, Axel Heidenreich, Roberto Salvioni, Mario Catanzaro, Daniele Raggi, Patrizia Giannatempo, Laura Marandino, Friederike Haidl, Filippo Pederzoli, Alberto Briganti, Francesco Montorsi, Juan Chipollini, Mounsif Azizi, Gert De Meerleer, Oscar R Brouwer, G Daniel Grass, Peter A Johnstone, Maarten Albersen, Philippe E Spiess, Andrea Necchi
San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Foundation Medicine Inc., Cambridge, MA, USA; Upstate Medical University, Syracuse, NY, USA., Fudan University Shanghai Cancer Center, Shanghai, China., Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil., St. George's University Hospitals NHS Foundation Trust, London, UK., University Hospital Rostock, Rostock, Germany., Universitätsklinikum Köln, Köln, Germany., Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Moffitt Cancer Center and Research Institute, Tampa, FL, USA., University Hospitals Leuven, Leuven, Belgium., The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Electronic address: ., San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/33199252