Diagnostic and prognostic impact of peritumoral stromal remodeling in patients with surgically treated invasive penile squamous cell cancer.
Stromal remodeling (SR), characterized by focal loss of CD34(+) fibrocytes paralleled by a gain of α-smooth muscle actin (α-SMA)-positive myofibroblasts, has been reported in several cancer types. However, the role of SR in invasive penile squamous cell cancer (PSC) has not been investigated so far. We compared 90 surgically treated PSCs (study group) and 55 control specimens (33 foreskins and 22 differentiated penile intraepithelial neoplasias) for the presence of stromal CD34(+) fibrocytes and α-SMA-positive myofibroblasts scored by independent raters. Multivariate proportional hazards regression analysis was used to assess the impact of staining profiles on cancer-specific mortality of the 90 PSCs (median follow-up, 32 months; interquartile range, 6-64). The incidence of SR differed significantly between study and control group specimens (51.1% versus 9.1%; P < .001). Five years postsurgically, 24% and 46% of the study patients without and with SR had succumbed to their PSC (P = .010). After adjusting for the age at the time of surgery, type of surgery, tumor size, Broders' grade, pT stage, and nodal status, study patients with SR showed 3.76-fold increased cancer-specific mortality (95% confidence interval, 1.3-10.5; P = .012). Our findings suggest that SR might have prognostic as well as some limited differential diagnostic value in terms of delineating invasive PSC from preinvasive lesions. However, our preliminary data clearly need to be validated by larger advanced studies in the future.
Institutes of Pathology at the Johanniter Hospital Stendal, 39576 Stendal, Germany. Electronic address: sven-gunia@gmx.de.
Sven
S
Gunia
HELIOS Clinic Bad Saarow, Charité-University Medicine Academic Teaching Hospital, 15526 Bad Saarow, Germany.
Anjun
A
Jain
Department of Urology and Institute of Legal Medicine, Forensic Medicine and Genetics, Hannover Medical School, 30625 Hannover, Germany.
Knut
K
Albrecht
HELIOS Clinic Bad Saarow, Charité-University Medicine Academic Teaching Hospital, 15526 Bad Saarow, Germany.
Stefan
S
Koch
Departments of Urology at the Caritas St Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany.
Wolfgang
W
Otto
Departments of Urology at the Caritas St Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany.
Stefan
S
Denzinger
Departments of Urology at the Caritas St Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany.
Stefanie
S
Götz
Departments of Urology at the Caritas St Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany.
Nina
N
Niessl
Departments of Urology at the Caritas St Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany.
Maximilian
M
Burger
St Elisabeth Clinic Straubing, 94315 Straubing, Germany.
Matthias
M
May
D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D005347:Fibroblasts / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000401:mortality / Q000473:pathology*; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D017154:Stromal Cells / Q000473:pathology; D059016:Tumor Microenvironment
D018952:Antigens, CD34
CD34(+) fibrocytes; Differential diagnosis; Penile squamous cell cancer (PSC); Prognostic outcome; Stromal remodeling (SR); α-smooth muscle actin (α-SMA)-positive myofibroblasts