Penile Squamous Cell Carcinomas in Sub-Saharan Africa and Europe: Differential Etiopathogenesis

Simple Summary We aimed to compare etiopathogenic features of 28 penile squamous cell carcinomas (PSCC) from Mozambique, an African country with a high prevalence of human papillomavirus (HPV) and HIV, with 51 PSCC from Spain, a European country with a low prevalence of HPV and HIV. All tumors underwent HPV testing and p16 and p53 immunohistochemistry. PSCC with either p16 overexpression and/or positivity for HPV were considered HPV-associated. The two sites showed striking etiopathogenic differences. Patients from Mozambique were significantly younger than those from Spain and showed mostly HPV-associated, p53-wild-type PSCC, contrary to older patients from Spain showing mostly HPV-independent, p53-altered tumors. These data may be valuable for primary prevention of PSCC worldwide. Penile squamous cell carcinomas (PSCC) are classified by the World Health Organization into two categories based on their relationship with the human papillomavirus (HPV): HPV-associated and HPV-independent. We compared a cohort of PSCC from Mozambique, a sub-Saharan country in southeast Africa with a high prevalence of HPV and HIV infection, and Spain, a country in southwestern Europe with a low prevalence of HPV and HIV, to study the distribution of the etiopathogenic categories of these tumors in both sites. A total of 79 PSCC were included in the study (28 from Mozambique and 51 from Spain). All cases underwent HPV-DNA polymerase chain reaction (PCR) testing, genotyping, and immunohistochemistry for p16 and p53. Any PSCC showing either p16 overexpression or HPV-DNA in PCR analysis was considered HPV-associated. Overall, 40/79 (50.6%) tumors were classified as HPV-associated and 39 (49.4%) as HPV-independent. The two sites showed marked differences: 25/28 (89.3%) tumors from Mozambique and only 15/51 (29.4%) from Spain were HPV-associated (p < 0.001). HPV16 was the most frequent HPV type identified in 64.0% (16/25) of the HPV-associated tumors from Mozambique, and 60.0% (9/15) from Spain (p = 0.8). On average, patients from Mozambique were almost two decades younger than those from Spain (mean age 50.9 +/- 14.9 and 69.2 +/- 13.3, respectively [p < 0.001]). In conclusion, significant etiopathogenic differences between PSCC in Mozambique and Spain were observed, with a remarkably high prevalence of HPV-associated tumors in Mozambique and a relatively low prevalence in Spain. These data may have important consequences for primary prevention of PSCC worldwide.