Abstract
Objective: To investigate the HPV DNA prevalence and genotype distribution among penile cancer in China. To identify association between HPV prevalence, different histological subtypes, tumor stage, tumor grade, demographics, comorbidity, and phimosis incidence trend. Standardized HPV DNA detection and p16INK4a expression were used in a multi-center series of 340 penile squamous cell carcinomas diagnosed from 2006 to 2017.Materials and Methods: HPV DNA detection and genotyping were examined by a validated kit for 23 different HPV subtypes (PCR-RDB HPV test). The cases with positive HPV DNA were additional tested for p16INK4a expression to confirm the HPV infection.Results: Using the PCR-RDB HPV test, overall HPV prevalence was 48.8% (166/340) and that of p16INK4a expression was 45.6%. In this studied population, HPV16 was the most frequent HPV type detected in HPV-positive cancers (76.5%). HPV18 was the second most common type in penile cancers (15.1%). After pathology review, 307 cases were confirmed as invasive penile cancer, and the other 33 were non-invasive caners. The histologic subtypes of warty, basaloid, clear cell papillary, adenosquamaous and pseudohyperplastic were showed high HPV DNA prevalence. Among invasive cancers, no statistically significant differences in prevalence were observed by tumor grade, tumor stage or lymphnode stage at diagnosis. HPV positive penile cancer incidence significantly increase and the phimosis incidence significantly decrease from 2006 to 2017.Conclusions: About a half of penile cancers were related to HPV infection. Our findings highlight the phimosis related penile cancers have been declining, the HPV related in the development of penile cancer and a fully aware of regional differences in HPV genotype distribution are tasks for penile cancer control and prevention.
Highlights
Penile cancer is relatively rare in the developed nations of Western Europe and the United States, with an age-standardized incidence of 0.3–1.0 per 100,000 men [1]
Cancers (Table 1), with most human papillomavirus (HPV) infections presenting as high-risk (163/166, 98.2%)
Our data indicate that the HPV DNA prevalence (48.8%) in China is as high as that in the United States, European Countries and South America [3, 10]
Summary
Penile cancer is relatively rare in the developed nations of Western Europe and the United States, with an age-standardized incidence of 0.3–1.0 per 100,000 men [1]. The prevalence of penile cancer in developing areas of Africa, Asia and South America ranges from 6 to 20 per 100,000 men [2]. The etiology of penile cancer is multifactorial; it is linked to inflammation, smoking, phimosis, poor personal hygiene, and human papillomavirus (HPV) infection [3]. HPV is regarded as the most frequently acquired sexually or not sexually transmitted disease, with more than 6 million new cases transmitted annually in the United States. HPV is implicated in both benign and malignant diseases, including cervical, head and neck, anal, and penile cancers. There is strong evidence linking the development of penile cancer to infection with high-risk HPV. Basaloid and warty penile squamous cell carcinomas are considered HPV-related, while non-HPV-related tumors mainly include the usual type, papillary type and verrucous carcinoma
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