Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma.

Abstract

To evaluate risk factors for survival in a large international cohort of patients with primary urethral cancer (PUC). A series of 154 patients (109 men, 45 women) were diagnosed with PUC in ten referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank test was used to investigate various potential prognostic factors for recurrence-free (RFS) and overall survival (OS). Multivariate models were constructed to evaluate independent risk factors for recurrence and death. Median age at definitive treatment was 66years (IQR 58-76). Histology was urothelial carcinoma in 72 (47%), squamous cell carcinoma in 46 (30%), adenocarcinoma in 17 (11%), and mixed and other histology in 11 (7%) and nine (6%), respectively. A high degree of concordance between clinical and pathologic nodal staging (cN+/cN0 vs. pN+/pN0; p<0.001) was noted. For clinical nodal staging, the corresponding sensitivity, specificity, and overall accuracy for predicting pathologic nodal stage were 92.8, 92.3, and 92.4%, respectively. In multivariable Cox-regression analysis for patients staged cM0 at initial diagnosis, RFS was significantly associated with clinical nodal stage (p<0.001), tumor location (p<0.001), and age (p=0.001), whereas clinical nodal stage was the only independent predictor for OS (p=0.026). These data suggest that clinical nodal stage is a critical parameter for outcomes in PUC.