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
Previous series reported no substantial difference in 5-year OS rates between the sexes [10,32,61], whereas in a recent SEER analysis female patients showed higher stage disease and 5-year CSM despite higher use of multimodal therapy [12,62]. Prognostic factors of worse survival in patients with primary urethral carcinoma are:
- advanced age (> 65 years) and black race [10,32,62,63];
- higher stage, grade, nodal involvement [54,64] and metastasis ;
- increased tumour size and proximal tumour location ;
- underlying (non-urothelial or unconventional) histology [10,30,33,63-66];
- presence of concomitant bladder cancer ;
- extent of surgical treatment and treatment modality [30,63,64];
- 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, gender, 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 SCC of the urethra, treatment in academic centres improves OS.