Estudo da expressão imunohistoquímica de SOX2 e ALDH1 como biomarcadores em pacientes portadores de carcinoma espinocelular do pênis / Immunohistochemical expression of sox2 and aldh1 as biomarkers in patients with penile squamous cell carcinoma

Introdução: O câncer de pênis pode chegar, em alguns países em desenvolvimento, até a 20% das neoplasias no homem. O tratamento padrão é a amputação do tumor primário e na linfadenectomia regional. A baixa acurácia dos métodos de estadiamento da doença linfonodal, que no momento é o fator prognóstico mais importante e a alta taxa de morbidade da linfadenectomia tem estimulado o estudo de novos fatores prognósticos preditivos de metástases em linfonodos, facilitando a seleção de pacientes a serem submetidos à linfadenectomia. Foram escolhidos SOX2 e ALDH1 por terem sido bons resultados preditivos em outros CEC, mas sem estudos em tecido peniano Objetivos: O presente estudo visa estudar a expressão imunoistoquímica de SOX 2 e ALDH1 no carcinoma peniano, além de identificar o valor prognóstico dessa expressão correlacionando-a com o tumor primário no risco de metástase linfonodal e a relação destes com as variáveis clinicas, demográficas e anatomopatológicas, bem como sua relação com sobrevida livre de doença e global. População e Métodos: Foram avaliados retrospectivamente 203 pacientes com diagnóstico de carcinoma epidermóide do pênis submetidos ao tratamento do tumor primário e a linfadenectomia radical ou aqueles submetidos ao tratamento do tumor primário, não linfadenectomizados, com pelo menos cinco anos de seguimento, utilizando a imunoistoquímica para analisar os marcadores. Resultados: A expressão de SOX2 esteve associada inversa e significantemente com o padrão de crescimento vertical e infiltração de corpo esponjoso e uretra, porém sem relação com sobrevida global ou câncer especifica. O biomarcador ALDH1 reagiu apenas com 2% da amostra, o que fez com que não pudéssemos avaliá-lo satisfatoriamente. Quando analisado metástase linfonodal, não houve diferença significante com a expressão nenhum dos marcadores. A infiltração perineural, metástase linfonodal, estdiamento pT foram os fatores independentes de pior sobrevida global Conclusão: SOX2, apesar de presente no carcinoma peniano, não se relacionou com metástase linfonodal ou sobrevida. ALDH1 não parece ser considerável em carcinoma peniano

Introduction: In some developing countries, up to 20% of all neoplasia in males is due to penile cancer. The standard treatment is primary tumor amputation and regional lymphadenectomy. The poor accuracy of lymph node staging methods, currently the most important prognostic factor and the high morbidity rate of lymphadenectomy, stimulated the study of new prognostic factors that predict lymph node metastases, facilitating the selection of patients for lymphadenectomy. SOX2 and ALDH1 were selected because they presented good predictive results in other squamous cell carcinomas, but studies on penile tissue were not available. Objectives: To study the immunohistochemical expression of SOX 2 and ALDH1 in penile carcinoma, as well as identify the prognostic value of this expression, correlate it with the primary tumor regarding risk of lymph node metastasis and the relationship with clinical, demographic and anatomopathological variables as well as disease-free and overall survival. Methods: 203 patients diagnosed with penile squamous cell carcinoma who underwent primary tumor treatment and radical lymphadenectomy or primary tumor treatment without lymphadenectomy with at least five years of follow-up were assessed using immunohistochemistry to analyze the markers. Results: The SOX2 expression was inversely and significantly related to the vertical growth pattern and the infiltration of the corpus spongiosum and urethra but without any relationship to overall or specific cancer survival. The biomarker ALDH1 only reacted with 2% of the samples, which meant it could not be satisfactorily evaluated. None of the markers presented a significant difference regarding lymph node metastasis. Perineural infiltration, lymph node metastasis, and staging pT were independent factors of poor overall survival. Conclusion: Although SOX2 is present in penile carcinoma, it is not related to lymph node metastasis or survival. ALDH1 does not appear to have a considerable presence in penile carcinoma

Sex with animals (SWA): behavioral characteristics and possible association with penile cancer. A multicenter study.

INTRODUCTION: Zoophilia has been known for a long time but, underreported in the medical literature, is likely a risk factor for human urological diseases. AIM: To investigate the behavioral characteristics of sex with animals (SWA) and its associations with penile cancer (PC) in a case-control study. METHODS: A questionnaire about personal and sexual habits was completed in interviews of 118 PC patients and 374 controls (healthy men) recruited between 2009 and 2010 from 16 urology and oncology centers. MAIN OUTCOME MEASURES: SWA rates, geographic distribution, duration, frequency, animals involved, and behavioral habits were investigated and used to estimate the odds of SWA as a PC risk factor. RESULTS: SWA was reported by 171 (34.8%) subjects, 44.9% of PC patients and 31.6% of controls (P < 0.008). The mean ages at first and last SWA episode were 13.5 years (standard deviation [SD] 4.4 years) and 17.1 years (SD 5.3 years), respectively. Subjects who reported SWA also reported more venereal diseases (P < 0.001) and sex with prostitutes (P < 0.001), and were more likely to have had more than 10 lifetime sexual partners (P < 0.001) than those who did not report SWA. SWA with a group of men was reported by 29.8% of subjects and SWA alone was reported by 70.2%. Several animals were used by 62% of subjects, and 38% always used the same animal. The frequency of SWA included single (14%), weekly or more (39.5%), and monthly episodes (15%). Univariate analysis identified phimosis, penile premalignancies, smoking, nonwhite race, sex with prostitutes, and SWA as PC risk factors. Phimosis, premalignant lesions, smoking, and SWA remained as risk factors in multivariate analysis. However, SWA did not impact the clinicopathological outcomes of PC. CONCLUSION: SWA is a risk factor for PC and may be associated with venereal diseases. New studies are required in other populations to test other possible nosological links with SWA.