Background:Penile squamous cell carcinoma (SCC) is now categorized based on human papillomavirus (HPV) status as HPV associated (SCCa) or HPV-independent. While most HPV-independent cases are of the usual type (Usual-SCCi), the prognostic significance of this subclassification—particularly between Usual-SCCi and other SCC HPV-independent variants (Variant-SCCi)—remains unclear.Materials and Methods:Using SEER data (2000–2021), patients with penile SCC were categorized into Usual-SCCi, Variant-SCCi (verrucous, papillary, and sarcomatoid), and SCCa groups. Cancer-specific survival (CSS) was evaluated using Kaplan–Meier estimates and Cox proportional hazard regression adjusted for demographic and clinical factors, with Firth’s penalized likelihood correction applied when appropriate. Temporal trends and subtype-specific outcomes were also analyzed.Results:Among 6332 patients, 5706 (90.1%) were Usual-SCCi, 416 (6.6%) were Variant-SCCi, and 210 (3.3%) were SCCa. Overall, 5-year CSS (proportion of patients (%) [95% CI]) was the highest in Variant-SCCi (90.9% [87.8–94.0]), compared to Usual-SCCi (73.7% [72.4–75.0]) and SCCa (71.5% [63.3–80.8). Within Variant-SCCi, verrucous SCC had the most favorable outcome (94.1% [91.3–97.0]), followed by papillary (81.9% [68.2–98.4]) and sarcomatoid (63.4% [47.4–84.7]). Multivariable analysis confirmed verrucous SCC as being independently associated with significantly lower cancer-specific mortality (HR: 0.31 [95% CI, 0.20–0.45];p< 0.001). Time-stratified analysis revealed that in the latter half of the study period, SCCa outcomes improved markedly, and no statistically significant differences in CSS were observed among the SCCa, papillary, and Usual-SCCi groups, leaving verrucous SCC as the only subtype with consistently superior survival (p< 0.001).Conclusions:The CSS of SCCa improved over time to become equivalent to those of the SCCi subtypes except for the verrucous SCCi variant, which had a significantly better CSS. Our study clearly demonstrates a temporal shift toward improved CSS in the SCCa subtype, which may be related to increased awareness following recognition as a separate entity in the WHO 2022 classification and other factors.
背景：阴茎鳞状细胞癌（SCC）目前根据人乳头瘤病毒（HPV）状态分为HPV相关型（SCCa）和HPV非依赖型。虽然大多数HPV非依赖型病例属于普通型（Usual-SCCi），但这种亚分类的预后意义——尤其是普通型与其他HPV非依赖型变异亚型（Variant-SCCi）之间的差异——仍不明确。 材料与方法：利用SEER数据库（2000-2021年）数据，将阴茎鳞状细胞癌患者分为普通型、变异型（包括疣状、乳头状和肉瘤样亚型）以及HPV相关型三组。采用Kaplan-Meier估计法和经人口学及临床因素校正的Cox比例风险回归模型评估癌症特异性生存率（CSS），并适时应用Firth惩罚似然校正法。同时分析了时间趋势及亚型特异性结局。 结果：在6332例患者中，普通型5706例（90.1%），变异型416例（6.6%），HPV相关型210例（3.3%）。总体5年CSS（患者比例%[95% CI]）显示：变异型生存率最高（90.9%[87.8-94.0]），普通型（73.7%[72.4-75.0]）和HPV相关型（71.5%[63.3-80.8]）次之。在变异型亚组中，疣状鳞癌预后最佳（94.1%[91.3-97.0]），其次为乳头状（81.9%[68.2-98.4]）和肉瘤样亚型（63.4%[47.4-84.7]）。多变量分析证实疣状鳞癌与显著降低的癌症特异性死亡率独立相关（HR: 0.31[95% CI, 0.20-0.45]; p<0.001）。时间分层分析显示，在研究后期，HPV相关型预后显著改善，其与乳头状亚型、普通型的CSS无统计学差异，仅疣状亚型始终保持显著更优的生存率（p<0.001）。 结论：HPV相关型的CSS随时间推移持续改善，最终达到与除疣状亚型外其他HPV非依赖型亚型相当的水平，而疣状亚型始终具有显著更优的CSS。本研究明确揭示了HPV相关型亚型的CSS随时间改善的趋势，这可能与WHO 2022分类将其列为独立类型后认知度的提升及其他因素有关。
肿瘤(癌症)患者之家