Georgios Gakis1, Todd M Morgan2, Jason A Efstathiou3, Kirk A Keegan4, Johannes Mischinger5, Tilman Todenhoefer5, Tina Schubert5, Harras B Zaid4, Jan Hrbacek6, Bedeir Ali-El-Dein7, Rebecca H Clayman3, Sigolene Galland3, Kola Olugbade2, Michael Rink8, Hans-Martin Fritsche9, Maximilian Burger9, Sam S Chang4, Marko Babjuk6, George N Thalmann10, Arnulf Stenzl5, Siamak Daneshmand11. 1. Department of Urology, University of Tübingen, Tübingen, Germany. georgios.gakis@web.de. 2. Department of Urology, University of Michigan, Ann Arbor, MI, USA. 3. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 4. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 5. Department of Urology, University of Tübingen, Tübingen, Germany. 6. Department of Urology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic. 7. Mansoura Clinic, Urology and Nephrology Center, Mansoura, Egypt. 8. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 9. Department of Urology, University Hospital Regensburg, Regensburg, Germany. 10. Department of Urology, University Hospital Berne, Berne, Switzerland. 11. USC/Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA, USA.
Abstract
PURPOSE: To evaluate risk factors for survival in a large international cohort of patients with primary urethral cancer (PUC). METHODS: A series of 154 patients (109 men, 45 women) were diagnosed with PUC in ten referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank test was used to investigate various potential prognostic factors for recurrence-free (RFS) and overall survival (OS). Multivariate models were constructed to evaluate independent risk factors for recurrence and death. RESULTS: Median age at definitive treatment was 66 years (IQR 58-76). Histology was urothelial carcinoma in 72 (47 %), squamous cell carcinoma in 46 (30 %), adenocarcinoma in 17 (11 %), and mixed and other histology in 11 (7 %) and nine (6 %), respectively. A high degree of concordance between clinical and pathologic nodal staging (cN+/cN0 vs. pN+/pN0; p < 0.001) was noted. For clinical nodal staging, the corresponding sensitivity, specificity, and overall accuracy for predicting pathologic nodal stage were 92.8, 92.3, and 92.4 %, respectively. In multivariable Cox-regression analysis for patients staged cM0 at initial diagnosis, RFS was significantly associated with clinical nodal stage (p < 0.001), tumor location (p < 0.001), and age (p = 0.001), whereas clinical nodal stage was the only independent predictor for OS (p = 0.026). CONCLUSIONS: These data suggest that clinical nodal stage is a critical parameter for outcomes in PUC.
PURPOSE: To evaluate risk factors for survival in a large international cohort of patients with primary urethral cancer (PUC). METHODS: A series of 154 patients (109 men, 45 women) were diagnosed with PUC in ten referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank test was used to investigate various potential prognostic factors for recurrence-free (RFS) and overall survival (OS). Multivariate models were constructed to evaluate independent risk factors for recurrence and death. RESULTS: Median age at definitive treatment was 66 years (IQR 58-76). Histology was urothelial carcinoma in 72 (47 %), squamous cell carcinoma in 46 (30 %), adenocarcinoma in 17 (11 %), and mixed and other histology in 11 (7 %) and nine (6 %), respectively. A high degree of concordance between clinical and pathologic nodal staging (cN+/cN0 vs. pN+/pN0; p < 0.001) was noted. For clinical nodal staging, the corresponding sensitivity, specificity, and overall accuracy for predicting pathologic nodal stage were 92.8, 92.3, and 92.4 %, respectively. In multivariable Cox-regression analysis for patients staged cM0 at initial diagnosis, RFS was significantly associated with clinical nodal stage (p < 0.001), tumor location (p < 0.001), and age (p = 0.001), whereas clinical nodal stage was the only independent predictor for OS (p = 0.026). CONCLUSIONS: These data suggest that clinical nodal stage is a critical parameter for outcomes in PUC.
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