Prognostic Factors for Penile Cancer and Survival in Response to Multimodality Therapy

Penile Cancer: Differences Between Patients Over and Under the Age of 75 Years

OBJECTIVES

We aimed to evaluate differences in patient characteristics, treatment, and cancer-specific survival between penile cancer patients aged 75 years or older and those younger than 75 years.

METHODS

One hundred ninety-six patients with penile cancer who were treated in 12 hospitals in the Kyushu-Okinawa region from 2009 to 2020 were retrospectively analyzed.

RESULTS

The older (age ≥ 75 years) and younger (age < 75 years) groups comprised 80 and 116 patients, respectively. Among all patients with clinical stage 3 disease and those with stage 3A alone, cancer-specific survival was significantly worse in the older group. Patients in the older group exhibited worse Eastern Cooperative Oncology Group Performance Status scores, lower albumin concentrations, and higher neutrophil-to-lymphocyte ratios. Treatment intensity was lower in the older patients, but the findings were not significant: partial penile resection was predominant in the older group, while patients in the younger group more frequently underwent total penile resection. In addition, pelvic lymph node dissection was less frequently performed in the older group.

CONCLUSIONS

Among patients with clinical stage 3 penile cancer, cancer-specific survival was worse in those aged 75 years or older. Worse Eastern Cooperative Oncology Group Performance Status scores and less aggressive treatment in the older group may have been contributing factors.

Human papillomavirus (HPV) and Epstein-Barr virus (EBV) in Penile Cancer in Thailand

BACKGROUND

Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are important etiological factors for several cancers. This study aimed to determine the prevalence of HPV and EBV infection in penile cancer.

METHODS

Forty-three formalin-fixed paraffin-embedded penile cancer tissue samples were analyzed for the HPV-induced p16INK4A protein by immunohistochemistry and Epstein-Barr encoding region in situ hybridization. Demographic data and overall survival were analyzed.

RESULTS

The median age of patients was 59 years, ranging from 23 to 91 years old. Most of the tumors (86%) were located at the tip of the penis. HPV infection was positive in 12/43 (27.9%) patients. EBV infection was observed in 2/43 (4.6%) of cases and there was no co-infection detected in this cohort. Patients who had p16INK4A overexpression had a trend toward longer survival compared to those without; the median survival time of 104.4 vs 89 months, the hazard ratio of 0.48 (95% CI: 0.16-1.42, p = 0.173).

CONCLUSIONS

One-third of penile cancer patients were positive for HPV-induced p16INK4A expression and there was a trend toward better survival in HPV-positive patients. EBV infection was infrequent in penile cancer in Thailand.

Venous thrombosis, multiple carcinomatous foci and differences in metastatic pathways of penile carcinoma

The aim of the present study was to explore the life-threatening complications and metastatic pathways of penile squamous cell carcinoma (SCC), as numerous patients with penile cancer are relatively young, are of good general health and have no visceral metastasis, yet have poor survival rates. A total of 94 patients with SCC of the penis who were surgically treated were included in the current study. The coagulation parameters, including prothrombin time (PT), fibrinogen and D-dimer, were analyzed. The patients' age ranged from 25 to 95 years (mean ± standard deviation, 53.3±1.4 years). A total of 77 patients (81.9%) underwent partial penectomy and 17 (18.1%) underwent radical penectomy. The PT was significantly different between patients whose tumour invaded the corpora cavenosum and those whose tumour had not invaded, and between patients with and without pelvic lymph node metastasis. A negative correlation was obtained between PT and pelvic lymph node metastasis. In addition, six typical SCC cases and one metastatic penile carcinoma case manifested with multiple carcinomatous foci, embolisms and evidence of a metastatic pathway occurring simultaneously with tumour progression were presented. The present study indicated that venous thrombosis is one of the life-threatening complications of advanced penile cancer. Furthermore, multiple carcinomatous foci were detected in histological images. Of note, direct clinical evidence for different metastatic pathways of primary and secondary penile carcinoma was provided.

Multimodal Treatment Combining Salvage Surgery-Assisted Chemotherapy and Checkpoints Blockade Immunotherapy Achieves Complete Remission on a Recurrent Penile Cancer Patient: A Case Report

Penile squamous cell carcinoma (pSCC) is a rare disease in developed countries. pSCC causes a severe health problem and social burden in developing countries. We reported a 49-year-old male recurrent pSCC patient with medium PD-L1 expression and low TMB. The patient obtained complete response after multimodal therapy (MMT). The clinical manifestation is a recurrence in the right groin with nearly ruptured pSCC. He had partial resection of penile cancer plus bilateral groin lymph node dissection and pelvic lymph node dissection during the first operation. Pathology of the recurrent tumor showed fibrous tissue with cancer infiltration and necrosis. We used MMT, including resection of palliative right inguinal metastases, four cycles of paclitaxel+bleomycin+cisplatin, and continuous sintilimab to treat the patient. The patient had a complete response (CR) after four cycles of therapy and sustained CR for 18 months with continuous sintilimab, showing a good tolerance and acceptable toxicity. This is the first case presenting a complete response in a relapsed pSCC patient. These results suggest that MMT is worth exploring.