SAN DIEGO, CA USA (UroToday.com) - The aim of this multi-institutional (9 tertiary academic centers) study was to evaluate risk factors for survival in a large international cohort of patients with primary urethral cancer.
A total of 126 patients (82 men, 44 women) were diagnosed with primary urethral cancer between 1993 and 2012. Descriptive statistics was used to investigate the role of tumor characteristics on treatment decisions. Kaplan-Meier analysis with log-rank test was used to investigate various potential prognostic factors for recurrence-free survival (RFS). A multivariate model was constructed to evaluate independent risk factors. The median follow-up of the cohort was 20 months (mean: 32 months; IQR: 4-48). Median age at definitive treatment was 63 years. Histopathologic analysis demonstrated urothelial cell carcinoma in 63 patients (50%), squamous cell carcinoma in 34 (27%), adenocarcinoma in 18 (14%), and other histology in 10 (8%). Mixed histology was present in 18 patients (14%). Patients with clinically advanced tumors were significantly more likely to undergo radical surgery (p=0.005) and perioperative chemotherapy (p=0.001). The 3- and 5-year RFS was 60.3% and 45.2%, and the 3- and 5-year overall survival 70.1 and 63.9%, respectively. In univariable analysis, advanced clinical/pathological stage (T3-T4 and/or N+) (p < 0.001/0.001), node-positive disease (p < 0.001), proximal tumor location (p=0.012), type of surgery (radical vs. urethral-sparing surgery; p < 0.001), and receipt of perioperative chemotherapy (p=0.05) were associated with inferior RFS. No significant associations were found for age, gender, history of bladder cancer, or underlying histology. In multivariable analysis, adjusted for significant parameters in univariate analysis, node-positive disease (p=0.016) and extent of surgery (p=0.013) remained independent predictors for inferior RFS.
Authors concluded that as node-positive patients exhibit significantly inferior survival, accurate nodal staging in urethral cancer is critical and allows uro-oncologist and clinical oncologists to direct these patients toward multimodal treatments. However, whether lymphadenectomy can improve survival in these patients remains unknown.
Presented by Georgios Gakis, Sia Daneshmand, Jason A. Efstathiou, Bedeir Ali-El-Dein, Jan Hrbacek, Kirk A. Keegan, Sigolene Galland, Rebecca Clayman, Lars Weissbach, Johannes Brunner, Harras B. Zaid, Tilman Todenhöfer, Michael Rink, Hans-Martin Fritsche, Sam S. Chang, Marko Babjuk, George Thalmann, and Arnulf Stenzl at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Reza Mehrazin, MD
