학술논문
Presence of HPV with overexpression of p16INK4a protein and EBV infection in penile cancer—A series of cases from Brazil Amazon.
Document Type
Article
Author
Martins, Valquíria do Carmo Alves; Cunha, Isabela Werneck; Figliuolo, Giuseppe; Rondon, Heidy Halanna de Melo Farah; de Souza, Paloma Menezes; Torres Silva, Felipe Luz; Torres Silva, Guilherme Luz; de Souza Bastos, Michele; de Castro, Daniel Barros; Santana, Monique Freire; Ramasawmy, Rajendranath; Levi, José Eduardo; Torres, Kátia Luz
Source
Subject
*PENILE cancer
*PENILE prostheses
*PAPILLOMAVIRUSES
*BIOMARKERS
*INFECTION
*CANCER hospitals
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Language
ISSN
1932-6203
Abstract
Background: In Brazil, penile cancer (PC) is not uncommon. The highest incidence of PC is in the North and Northeast of the country. In addition to phimosis, the Human Papillomavirus (HPV) and Epstein-Baar Virus (EBV) infections are also related as risk factors for PC. The overexpression of p16INK4a is a surrogate sensitive marker of HPV infection in PC. Objectives: To correlate p16INK4a overexpression and HPV infection status with EBV infection in a series of PC patients from the Amazon region. Methods: Tumor tissues from 47 PC cases were analyzed for the presence of HPV and EBV DNA by PCR. All PC patients were diagnosed between 2013 and 2018 at a public reference cancer center hospital in Manaus, Amazonas—Brazil. HPV was genotyped using E7 HPV16/HPV18 type-specific real-time PCR and the PapilloCheck® HPV-Screening assay. p16INK4a expression was evaluated by immunohistochemistry using the automated Ventana® BenchMark Ultra. Results: The mean age of patients at the time of diagnosis was 57.4 years ±SD 17.8 ranging from 20 to 90 years old. Most of the patients (64%) came from rural areas of the Amazonas State. Thirty patients had phimosis (64%). Among the patients with phimosis, 43% (13/30) underwent circumcision, three during childhood and 10 in adulthood. 60% of the patients were smokers or ex-smokers. HPV infection was observed in 45% (21/47) of cases. HPV16 was detected in 13 patients (61%). Other HPV types detected were HPV 6, 11, 42, 51, 53, 68 and 44/55. EBV infection was observed in 30% (14/47) of the patients with PC. Co-infection with HPV and EBV was observed in 28% (6/21) cases. p16INK4a was only investigated in 26 samples. The p16INK4a overexpression was observed exclusively in HPV 16 positive cases and four HPV negative cases. In the survival analysis, the follow-up time was 35.4 months/patient. The mortality rate during the follow up time was 38%. Conclusions: p16INK4a positivity presented a high correlation to HPV 16 DNA detection, reinforcing its use as a surrogate marker for HPV-driven cancers. Infection with EBV was quite frequent and its role in epithelial penile oncogenesis needs to be demonstrated. [ABSTRACT FROM AUTHOR]