Dillner J, von Krogh G, Horenblas S, Meijer C J
Microbiology & Tumor Biology Center, Karolinska Institute, Stockholm, Sweden.
Scand J Urol Nephrol Suppl. 2000(205):189-93. doi: 10.1080/00365590050509913.
To review the epidemiology of invasive cancer of the penis based on scientific publications identified by a Medline search from 1966-2000 for the keywords penis/penile, cancer/carcinoma and risk as well as the cited references in the identified papers.
Strong risk factors (OR >10) identified by case-control studies included phimosis, chronic inflammatory conditions such as balanopostitis and lichen sclerosus et atrophicus and treatment with psoralen and ultraviolet A photochemotheraphy (PUVA). A consistent association was found between penile cancer and smoking that was dose-dependent and not explained by investigated confounding factors such as sexual history. Sexual history and self-reported history of condyloma were associated with a 3-5-fold increased penile cancer risk. Cervical cancer in the wife was not consistently associated with cancer of the penis in the husband. Circumcision was associated with penile cancer risk in ecological studies. In a case-control study, circumcision neonatally, but not after the neonatal period, was associated with a 3-fold decreased risk, albeit 20% of penile cancer patients had been circumcised neonatally. In a large number of case series, human papillomavirus (HPV) DNA was identified in penile neoplastic tissue. In penile intraepithelial neoplasia, between 70 and 100% of lesions were HPV DNA positive, whereas invasive penile cancer was positive in only 40-50% of cases. A few serological case-control studies and one prospective study also identified an association between HPV type 16 and penile cancer risk. An association between penile cancer risk and HPV prevalence in the population was also suggested by ecological studies.
The evidence on risk factors for penile cancer suggests that preventive measures that could be considered include prevention of phimosis, treatment of chronic inflammatory conditions, limiting PUVA treatment, smoking cessation and prophylactic prevention of HPV infection.
基于通过Medline检索1966年至2000年期间以阴茎/阴茎的、癌症/癌以及风险为关键词所识别出的科学出版物，以及所识别论文中的参考文献，回顾阴茎浸润癌的流行病学情况。
病例对照研究确定的强风险因素（比值比>10）包括包茎、慢性炎症性疾病如阴茎头炎和萎缩性硬化苔藓以及补骨脂素和紫外线A光化学疗法（PUVA）治疗。阴茎癌与吸烟之间存在一致关联，这种关联呈剂量依赖性，且未被诸如性病史等所研究的混杂因素所解释。性病史和自我报告的尖锐湿疣病史与阴茎癌风险增加3至5倍相关。妻子患宫颈癌与丈夫患阴茎癌之间未发现一致关联。在生态学研究中，包皮环切术与阴茎癌风险相关。在一项病例对照研究中，新生儿期进行包皮环切术而非新生儿期后进行包皮环切术与风险降低3倍相关，尽管20%的阴茎癌患者在新生儿期进行了包皮环切术。在大量病例系列中，在阴茎肿瘤组织中鉴定出人乳头瘤病毒（HPV）DNA。在阴茎上皮内瘤变中，70%至100%的病变HPV DNA呈阳性，而浸润性阴茎癌仅40%至50%的病例呈阳性。一些血清学病例对照研究和一项前瞻性研究也确定了16型HPV与阴茎癌风险之间的关联。生态学研究也提示了人群中HPV流行率与阴茎癌风险之间的关联。
关于阴茎癌风险因素的证据表明，可考虑的预防措施包括预防包茎、治疗慢性炎症性疾病、限制PUVA治疗、戒烟以及预防性预防HPV感染。
