Guidelines

Primary Urethral Carcinoma

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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]. An analysis of data collected between 2000 and 2020 by the SEER database, including 512 patients with non-metastatic PUC, reported CSM rates of 38.2% at five years. In 278 PUC patients with T1–T2, N0 disease and 234 PUC patients with T3–T4, N0–N2 disease, the five-year CSM rates at initial diagnosis was 68.4% and 53.8%, respectively [57]. Based on longer follow-up, an analysis of the SEER database comparing prognostic factors in rare pathological types of PUC (n = 257) and common pathological groups (n = 2,651), reported ten-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 males versus females [8,30,60], whereas in a SEER analysis, female patients showed a higher disease stage and five-year CSM despite the higher use of multimodal therapy [10,61]. Prognostic factors of worse survival in patients with PUC are:

  • advanced age (> 65 years) and Black ethnicity [8, 30, 61, 62]
  • unmarried status, as defined by the SEER field description [63]
  • higher stage, grade, nodal involvement [52,64] and metastasis [28]
  • increased tumour size and proximal tumour location [28]
  • non-urothelial or unconventional histology [8, 28, 62 ,64-67]
  • presence of concomitant bladder cancer [40]
  • scope of surgical treatment and treatment modality [28, 62, 64]
  • treatment in non-academic centres [68]
  • location of recurrence (solitary or concomitant urethral sites vs. nonurethral sites) [69]

Some limitations must be considered when interpreting these results as the number of patients included in most studies were low [66].

6.3. Summary of evidence for prognosis

Summary of evidenceLE
Prognostic factors for survival in PUC: age, sex, ethnicity, 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 UC and SCC of the urethra, treatment in academic centres improves OS.3