Guidelines

Primary Urethral Carcinoma

6. PROGNOSIS

6.1. Long-term survival after primary urethral carcinoma

According to the RARECARE project, the one- and 5-year relative overall survival (OS) rates in patients with urethral carcinoma in Europe are 71% and 54%, respectively [10]. Based on longer follow-up, an analysis of the SEER database, comparing prognostic factors in rare pathological types of primary urethral carcinoma (n = 257) and common pathological groups (n = 2,651), reported 10-year OS rates of 42.4% and 31.9%, respectively [59]. Cancer-specific survival (CSS) rates at five and ten years were 68% and 60%, respectively [60]. Age (> 60 years), race (others vs. whites), T-stage (T3/T4 vs. Ta-T2) and M-stage (M1 vs. M0) were independent prognostic risk factors for OS and CSS in rare pathological variants [59].

6.2. Predictors of survival in primary urethral carcinoma

In Europe, 5-year OS rate does not substantially differ between the sexes [10,32]. Prognostic factors of worse survival in patients with primary urethral carcinoma are:

  • advanced age (> 65 years) and black race [10,32,61,62];
  • higher stage, grade, nodal involvement [55,62] and metastasis [30];
  • increased tumour size and proximal tumour location [30];
  • underlying (non-urothelial) histology [10,30,61-64];
  • presence of concomitant bladder cancer [42];
  • extent of surgical treatment and treatment modality [30,61,62];
  • treatment in academic centres [65];
  • location of recurrence (urethral vs. non-urethral) [66].

Some limitations have to be considered when interpreting these results as the number of patients included in most studies were low [63].

6.3. Summary of evidence for prognosis

Summary of evidence

LE

Prognostic factors for survival in primary urethral carcinoma are: age, race, tumour stage and grade, nodal stage, presence of distant metastasis, histological type, tumour size, tumour location, concomitant bladder cancer and type and modality of treatment.

3

In locally advanced urothelial and squamous cell carcinoma of the urethra, treatment in academic centres improves overall survival.

3