THE CORRELATION BETWEEN p16 AND p53 PROTEIN EXPRESSION WITH PATHOLOGICAL T STAGE (pT) AND LYMPH NODE METASTASIS IN PENILE SQUAMOUS CELL CARCINOMA AT PROF. DR. I.G.N.G. NGOERAH HOSPITAL

Abstract

Background: Penile carcinoma is a rare cancer worldwide. Approximately 95% of penile cancers are classified as penile squamous cell carcinoma (PSCC). Bali province has the highest incidence of PSCC in Indonesia. The prognosis of PSCC causes psychological trauma and becomes worse when the disease is diagnosed at advanced stages, making treatment more complex. The pathological stage and lymph node metastasis status are significant prognostic factors. The expression of p16 and p53 proteins plays a role in the classification and prognosis of PSCC. Various studies have shown that PSCC with positive p16 expression has a better prognosis compared to PSCC with abnormal p53 expression. Although the relationship between p16 and p53 expression and prognostic factors has been widely studied, research combining both p16 and p53 expressions remains limited. This study aims to evaluate the relationship between the expression of p16 and p53 proteins with pathological T stage and lymph node metastasis status in PSCC patients, as prognostic markers.

Methods: This study is an observational analytical research with a cross-sectional design. The sample consists of PSCC patients whose specimens were examined at the Anatomical Pathology Laboratory of Prof. Dr. I.G.N.G. Ngoerah Hospital from January 1, 2019, to June 30, 2025, according to the inclusion and exclusion criteria set by the researchers, with a sample size of 43 patients. Immunohistochemistry was performed using p16INK4A clone JC2 and p53 clone DO-7. The research results were analysed using Chi-square analysis to assess the relationship between p16 and p53 protein expression with pathological T stage and lymph node metastasis, with a significance level of p<0.05.

Results: The study found that the patients' age ranged from 32 to 97 years, with a mean age of 60.09±14.046 years. The most cases were at advanced stages (26 cases), and most patients showed no lymph node metastasis (31 cases). Immunohistochemical examination revealed that most cases had negative p16 expression (30 cases) and abnormal p53 expression (36 cases). Regarding the combination of p16 and p53 expressions, 26 cases showed negative p16 and abnormal p53, 10 cases showed positive p16 and abnormal p53, 4 cases showed negative p16 and normal p53, and 3 cases showed positive p16 and normal p53. However, based on Chi-square analysis, there was no statistically significant relationship between p16 and p53 protein expression and pathological T stage (p = 0.493) or lymph node metastasis (p = 0.506).

Conclusion: There is no significant relationship between p16 and p53 protein expression and pathological T stage or lymph node metastasis in SCCP.