943 PROGNOSTIC FACTORS AND OUTCOMES AFTER DEFINITIVE TREATMENT FOR PRIMARY URETHRAL CANCER: RESULTS FROM THE INTERNATIONAL COLLABORATION ON PRIMARY URETHRAL CARCINOMA
2013-03-27

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (III)1 Apr 2013943 PROGNOSTIC FACTORS AND OUTCOMES AFTER DEFINITIVE TREATMENT FOR PRIMARY URETHRAL CANCER: RESULTS FROM THE INTERNATIONAL COLLABORATION ON PRIMARY URETHRAL CARCINOMA Georgios Gakis, Sia Daneshmand, Jason A. Efstathiou, Bedeir Ali-El-Dein, Jan Hrbacek, Kirk A. Keegan, Sigolene Galland, Rebecca Clayman, Lars Weissbach, Johannes Brunner, Harras B. Zaid, Tilman Todenhöfer, Michael Rink, Hans-Martin Fritsche, Sam S. Chang, Marko Babjuk, George Thalmann, and Arnulf Stenzl Georgios GakisGeorgios Gakis Tuebingen, Germany More articles by this author , Sia DaneshmandSia Daneshmand Los Angeles, CA More articles by this author , Jason A. EfstathiouJason A. Efstathiou Boston, MA More articles by this author , Bedeir Ali-El-DeinBedeir Ali-El-Dein Mansoura, Egypt More articles by this author , Jan HrbacekJan Hrbacek Prague, Czech Republic More articles by this author , Kirk A. KeeganKirk A. Keegan Nashville, TN More articles by this author , Sigolene GallandSigolene Galland Boston, MA More articles by this author , Rebecca ClaymanRebecca Clayman Boston, MA More articles by this author , Lars WeissbachLars Weissbach Hamburg, Germany More articles by this author , Johannes BrunnerJohannes Brunner Regensburg, Germany More articles by this author , Harras B. ZaidHarras B. Zaid Nashville, TN More articles by this author , Tilman TodenhöferTilman Todenhöfer Tuebingen, Germany More articles by this author , Michael RinkMichael Rink Hamburg, Germany More articles by this author , Hans-Martin FritscheHans-Martin Fritsche Regensburg, Germany More articles by this author , Sam S. ChangSam S. Chang Nashville, TN More articles by this author , Marko BabjukMarko Babjuk Prague, Czech Republic More articles by this author , George ThalmannGeorge Thalmann Bern, Switzerland More articles by this author , and Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.522AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary urethral cancer is a rare malignancy with an annual incidence of 1.1/1,000,000 in the U.S. Therefore, treatment options and their impact on outcomes have not been well defined. The aim of the present study was to evaluate risk factors for survival in a large international cohort of patients with primary urethral cancer. METHODS A total of 126 patients (82 men, 44 women) were diagnosed with primary urethral cancer between 1993 and 2012 in nine tertiary international academic centers. Descriptive statistics was used to investigate the role of tumor characteristics on treatment decisions. Kaplan-Meier analysis with log-rank test was used to investigate various potential prognostic factors for recurrence-free survival (RFS). A multivariate model was constructed to evaluate independent risk factors. The median follow-up of the cohort was 20 months (mean: 32 months; IQR: 4-48). RESULTS Median age at definitive treatment was 63 years (IQR: 53-74). Histopathologic analysis demonstrated urothelial cell carcinoma in 63 patients (50%), squamous cell carcinoma in 34 (27%), adenocarcinoma in 18 (14%) and other histology in 10 (8%). Mixed histology was present in 18 patients (14%). Clinical tumor stage correlated highly with pathological tumor stage after definitive treatment (p<0.001). Patients with clinically advanced tumors were significantly more likely to undergo radical surgery (p=0.005) and perioperative chemotherapy (p=0.001). The 3- and 5-year RFS was 60.3% and 45.2%, and the 3- and 5-year overall survival 70.1 and 63.9%, respectively. In univariable analysis, advanced clinical/pathological stage (T3-T4 and/or N+) (p<0.001/0.001), node-positive disease (p<0.001), proximal tumor location (p=0.012), type of surgery (radical vs. urethral-sparing surgery; p<0.001) and receipt of perioperative chemotherapy (p=0.05) were associated with inferior RFS. No significant associations were found for age, gender, history of bladder cancer nor underlying histology. In multivariable analysis, adjusted for significant parameters in univariate analysis, node-positive disease (p=0.016) and extent of surgery (p=0.013) remained independent predictors for inferior RFS. CONCLUSIONS Nodal stage is a critical parameter in primary urethral cancer since patients with node-positive disease exhibit significantly inferior survival. With regard to the high degree of concordance between clinical and pathological staging, multimodal treatment should be strongly considered for these patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e388 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georgios Gakis Tuebingen, Germany More articles by this author Sia Daneshmand Los Angeles, CA More articles by this author Jason A. Efstathiou Boston, MA More articles by this author Bedeir Ali-El-Dein Mansoura, Egypt More articles by this author Jan Hrbacek Prague, Czech Republic More articles by this author Kirk A. Keegan Nashville, TN More articles by this author Sigolene Galland Boston, MA More articles by this author Rebecca Clayman Boston, MA More articles by this author Lars Weissbach Hamburg, Germany More articles by this author Johannes Brunner Regensburg, Germany More articles by this author Harras B. Zaid Nashville, TN More articles by this author Tilman Todenhöfer Tuebingen, Germany More articles by this author Michael Rink Hamburg, Germany More articles by this author Hans-Martin Fritsche Regensburg, Germany More articles by this author Sam S. Chang Nashville, TN More articles by this author Marko Babjuk Prague, Czech Republic More articles by this author George Thalmann Bern, Switzerland More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...