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World Journal of Urology

, Volume 36, Issue 9, pp 1431–1440 | Cite as

The relationship between HPV status and chemoradiotherapy in the locoregional control of penile cancer

  • Zhigang Yuan
  • Arash O. Naghavi
  • Dominic Tang
  • Youngchul Kim
  • Kamran A. Ahmed
  • Jasreman Dhillon
  • Anna R. Giuliano
  • Philippe E. Spiess
  • Peter A. Johnstone
Original Article

Abstract

Background

Penile cancer (PeCa) is a rare, aggressive malignancy often associated with the human papillomavirus (HPV). The practice of a personalized risk-adapted approach is not yet established. This study is to assess the relationship between HPV tumor status and chemoradiotherapy (CRT) in PeCa locoregional control (LRC).

Methods

We retrospectively identified patients with HPV status who were diagnosed with squamous cell carcinoma of the penis and treated with surgical resection between 1999 and 2016. The relationship between tumor/treatment characteristics and LRC were analyzed with univariate and multivariate Cox proportional hazard regression analysis (UVA and MVA, respectively). Time-to-event outcomes were estimated with Kaplan–Meier curves and compared via log-rank tests.

Results

Fifty-one patients were identified. The median follow-up was 36.6 months. Patients were primarily HPV-negative (HPV−) (n = 28, 55%), and pathologic node positive (pN+) (55%). The 2 year LRC rate was 54%. pN+ patients had a significantly lower 2 year LRC (37 vs. 81%, p = 0.002). In the subgroup analysis of pN+ patients (n = 28), there was a LRC benefit associated with the addition of CRT (HR 0.19; 95% CI 0.05–0.70, p = 0.012) and HPV-positive (HPV+) disease (HR 0.18; 95% CI 0.039–0.80, p = 0.024) using MVA. HPV+ patients treated with CRT had improved 2 year LRC compared to HPV− patients (83 vs. 38%, p = 0.038).

Conclusions

Adjuvant CRT and HPV+ disease independently predicted for improved LRC in pN+ PeCa. In HPV+ PeCa, the LRC benefit was primarily observed in patients treated with adjuvant CRT. Prospective investigation of HPV+ and CRT is required to further delineate their roles in optimizing PeCa treatment.

Keywords

Chemoradiation therapy HPV Penile cancer Locoregional recurrence Surgery 

Notes

Author contributions

ZGY: Project development, data collection, manuscript writing. AON: project development, data analysis, manuscript writing. DT: project development, data collection. KAA: project development, data analysis, manuscript writing. JD: data collection. PAJ, PES, and ARG: project development, manuscript writing. YC Kim: data analysis.

Compliance with ethical standards

Conflict of interest

Dr. Anna R. Giuliano is on a member of Merck’s Scientific and Global Advisory Boards and receives funding form Merck for investigator initiated studies related to HPV. The other authors declare that they have no conflict of interest.

Research involving human participants and/or animals

For this type of study formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

345_2018_2280_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Zhigang Yuan
    • 1
  • Arash O. Naghavi
    • 1
  • Dominic Tang
    • 2
  • Youngchul Kim
    • 3
  • Kamran A. Ahmed
    • 1
  • Jasreman Dhillon
    • 4
  • Anna R. Giuliano
    • 5
  • Philippe E. Spiess
    • 2
  • Peter A. Johnstone
    • 1
  1. 1.Department of Radiation OncologyH Lee Moffitt Cancer Center and Research InstituteTampaUSA
  2. 2.Department of Genitourinary OncologyH Lee Moffitt Cancer Center and Research InstituteTampaUSA
  3. 3.Department of Biostatistics and BioinformaticsH Lee Moffitt Cancer Center and Research InstituteTampaUSA
  4. 4.Department of Anatomic PathologyH Lee Moffitt Cancer Center and Research InstituteTampaUSA
  5. 5.Department of Cancer EpidemiologyH Lee Moffitt Cancer Center and Research InstituteTampaUSA

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