The prognostic value of p53 and Ki-67 expression status in penile cancer: a systematic review and meta-analysis

This meta-analysis aimed to explore penile cancer survival based on p53 and Ki-67 status. A systematic literature search identified studies assessing overall and cancer-specific survival after penile cancer with p53 or Ki-67 expression. Pooled hazard ratios (HRs) and restricted mean survival time (RMST) differences were calculated using a random-effects model. The analysis included 930 and 391 men for p53 expression in overall survival (OS) and cancer-specific survival (CSS), respectively. Those with the p53 mutant pattern exhibited significantly worse OS and CSS compared to the p53 wild-type pattern (HROS=2.42, 95% CI 1.75-3.34; HRCSS=4.18, 95% CI 1.87-9.35). The 5-year RMST difference for OS, according to p53 status, was -10.62 months (95% CI -16.20 to -5.03). We included 202 men with penile cancer tested for Ki-67 expression and found an HR of CSS of 1.96 (95% CI 1.15-3.32). In conclusion, men with the p53 mutant pattern penile cancer have worse OS and CSS than men with p53 wild-type pattern penile cancer. Evidence regarding Ki-67 status was sparse, but the pooled estimate indicated that penile cancers with high Ki-67 expression may have a slightly worse CSS than those with low Ki-67 expression. These findings may inform clinicians when planning the best management and follow-up strategy for penile cancer patients.