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 . 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 . Cancer-specific survival (CSS) rates at five and ten years were 68% and 60%, respectively . 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 .
6.2. Predictors of survival in primary urethral carcinoma
- advanced age (> 65 years) and black race [10,32,61,62];
- higher stage, grade, nodal involvement [55,62] and metastasis ;
- increased tumour size and proximal tumour location ;
- underlying (non-urothelial) histology [10,30,61-64];
- presence of concomitant bladder cancer ;
- extent of surgical treatment and treatment modality [30,61,62];
- treatment in academic centres ;
- location of recurrence (urethral vs. non-urethral) .
Some limitations have to be considered when interpreting these results as the number of patients included in most studies were low .
6.3. Summary of evidence for prognosis
Summary of evidence
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.
In locally advanced urothelial and squamous cell carcinoma of the urethra, treatment in academic centres improves overall survival.