ABSTRACT
Objective:
To investigate the clinical characteristics and
prognostic factors of primary
urethral cancer.
Methods:
The clinical data of 35
patients with primary
urethral cancer admitted to the First Affiliated
Hospital of Zhengzhou
University from January 2011 to April 2022 were retrospectively analyzed. There were 12
males (34.3%) and 23
females (65.7%). The average age was 61.1 ± 13.0 years old. The clinical symptoms included 13 cases of
urethral obstruction (37.1%), 7 cases of
hematuria (20.0%), 6 cases of urethral
bleeding (17.1%), 5 cases of
urinary tract irritation (14.3%), 1 case of
Urinary incontinence (2.9%), 1 case of
low back pain (2.9%), 1 case of scrotal
ulcer (2.9%), and 1 case (2.9%) by
self examination. All
patients underwent cystourethroscopy and
tissue biopsy. The
biopsy pathology showed 16 cases of urothelial
carcinoma, 7 cases of
squamous carcinoma, 4 cases of
adenocarcinoma, 3 cases of
malignant melanoma, 1 case of urothelial
carcinoma with
squamous carcinoma, 1 case of
Signet ring cell carcinoma, 1 case of sarcomatoid
carcinoma, 1 case of embryonic
Rhabdomyosarcoma, and 1 case of epithelioid
angiosarcoma. The
tumors were located in the proximal
urethra in 13 cases (37.1%) and in the distal
urethra in 22 cases (62.9%). There were 14 cases (40.0%) with a maximum diameter of less than 3 cm, 16 cases (45.7%) with a diameter of ≥ 3 cm, and 5 cases (14.3%) with mucosal
abnormalities. There were 12 cases of T 1 stage, 9 cases of T 2 stage, 7 cases of T 3 stage, and 7 cases of T 4 stage in
tumor staging. Imaging evaluation of
lymph nodes showed 25 cases of N 0 stage, 2 cases of N 1 stage, and 8 cases of N 2 stage; A total of 11 cases of
lymph node biopsy were performed (including 8 cases of intraoperative
lymph node dissection and 3 cases of preoperative
lymph node biopsy), of which 6 cases had
lymph node metastasis, and 1 case was initially diagnosed with distant
metastasis. Thirty-one cases underwent surgical
treatment, of which 16 cases underwent radical urethrectomy, and 8 cases underwent intraoperative pelvic and bilateral inguinal
lymph node dissection, 8 cases underwent resection of urethral
tumors, and 7 cases underwent transurethral resection of
tumors. Four cases did not undergo surgical
treatment, while 1 case had epithelioid
angiosarcoma and received
radiotherapy combined with
chemotherapy, 2 cases received
chemotherapy with GC (
Gemcitabine+
cisplatin) regimen, and 1 case received
immunotherapy with
immune checkpoint inhibitors. The
risk factors that affected
patient prognosis were analyzed.
Results:
All 35 cases in this group were followed up, with a median follow-up
time of 22 (2, 122) months. Seventeen cases survived, 18 cases died, and the overall median
survival duration was 23 (13 to not reached) months. The overall 5-year
survival rate was 45%. The results of univariate
analysis showed that clinical T-stage ( P=0.019), maximum
tumor diameter ( P=0.016), and
tumor location ( P=0.006) were independent
risk factors affecting
patient prognosis. Result of
multivariate analysis showed that the maximum diameter of the
tumor ≥ 3 cm ( HR=2.673, P=0.029) and the proximal
location of the
tumor ( HR=3.064, P=0.023) were independent
risk factors affecting
patient survival.
Gender, age,
treatment method,
lymph node dissection,
adjuvant radiotherapy,
adjuvant chemotherapy, clinical manifestations, pathological type, clinical N staging, and pathological N staging had no significant impact on
patient survival rate ( P>0.05). Single
factor analysis was conducted on
female patients separately, and only
tumor location was found to be a
prognostic factor ( χ2=17.246, P<0.01).
Conclusions:
Primary
urethral cancer is a
rare disease with various symptoms and poor
prognosis. The maximum diameter of the
tumor ≥3 cm and the
tumor located at the proximal end of the
urethra are clinical
risk factors affecting the
prognosis of
patients with primary
urethral cancer.