Primary Urethral Carcinoma

6. PROGNOSIS

6.1. Long-term survival after primary urethral carcinoma

According to the RARECARE project, the one- and five-year relative overall survival (OS) rates in patients with urethral carcinoma in Europe are 71% and 54%, respectively [8]. 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 [58]. Cancer-specific survival (CSS) rates at five and ten years were 68% and 60%, respectively [59]. 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 [58].

6.2. Predictors of survival in primary urethral carcinoma

Previous series reported no substantial difference in five-year OS rates between the sexes [8,30,60], whereas in a recent SEER analysis female patients showed higher stage disease and five-year CSM despite higher use of multimodal therapy [10,61]. Prognostic factors of worse survival in patients with primary urethral carcinoma are:

• advanced age (> 65 years) and black race [8,30,61,62];
• higher stage, grade, nodal involvement [53,63] and metastasis [28];
• increased tumour size and proximal tumour location [28];
• underlying (non-urothelial or unconventional) histology [8,28,31,62-65];
• presence of concomitant bladder cancer [41];
• extent of surgical treatment and treatment modality [28,62,63];
• treatment in academic centres [66];
• location of recurrence (urethral vs. non-urethral) [67].

Some limitations have to be considered when interpreting these results as the number of patients included in most studies were low [64].

6.3. Summary of evidence for prognosis