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Guidelines

Primary Urethral Carcinoma

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  1. Introduction
  2. Methods
  3. Epidemiology Aetiology And Pathology
  4. Staging And Classification Systems
  5. Diagnostic Evaluation And Staging
  6. Prognosis
  7. Disease Management
  8. Follow Up
  9. References
  10. Conflict Of Interest
  11. Citation Information
6. Prognosis
  • 1. Introduction
  • 2. Methods
  • 3. Epidemiology Aetiology And Pathology
  • 4. Staging And Classification Systems
  • 5. Diagnostic Evaluation And Staging
  • 6. Prognosis
  • 7. Disease Management
  • 8. Follow Up
  • 9. References
  • 10. Conflict Of Interest
  • 11. Citation Information
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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]. 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

Summary of evidence

LE

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.

3

In locally-advanced urothelial- and SCC- of the urethra, treatment in academic centres improves OS.

3

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