Primary Urethral Cancer - Treatment Patterns and Associated Outcomes

OBJECTIVES: To evaluate treatment patterns and associated outcomes of patients with urethral cancer. PATIENTS AND METHODS: After obtaining IRB approval we identified 165 patients treated for primary urethral cancer between 1956-2017. Treatment included monotherapy (surgery or radiation), dual-therapy (surgery+radiation, surgery+chemotherapy, or chemotherapy+radiation) or triple-therapy (surgery+radiation+chemotherapy). Rates of different treatments were described by treatment year. The association between treatment type and outcomes was evaluated with multivariate Cox-regression models adjusting for disease characteristics. RESULTS: The study cohort included 74 males and 91 females with a median age of 61 years. Common histologies were squamous-cell (36%), urothelial (27%) and adenocarcinoma (25%). At presentation, 72% of patients had invasive disease, 24% had nodal involvement, and 5% had metastases. Treatment included monotherapy (57%), dual-therapy (21%), and triple-therapy (10%). The use of monotherapy decreased over time, while rates of dual-therapy remained consistent, and rates of triple-therapy increased. Median followup was 4.7 years. Estimated five-year local recurrence-free, disease-specific and overall survival were 51%, 48% and 41%, respectively. Monotherapy was associated with decreased local recurrence-free survival after adjusting for stage, histology, sex and year of treatment (p=0.017). There was no evidence that treatment type was associated with distant recurrence, cancer-specific and overall survival. CONCLUSIONS: We found preliminary evidence that multimodal therapy, more commonly used in recent years, was of benefit in patients with primary urethral cancer. This finding should be confirmed in further studies involving multiple centers due to the low incidence of the disease.