The relationship between HPV status and chemoradiotherapy in the locoregional control of penile cancer
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).
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.
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).
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.
KeywordsChemoradiation therapy HPV Penile cancer Locoregional recurrence Surgery
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 was obtained from all individual participants included in the study.
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