Oncological Outcomes of Patients with Concomitant Bladder and Urethral Carcinoma

Gakis, Georgios; Efstathiou, Jason A.; Daneshmand, Siamak; Keegan, Kirk A.; Clayman, R.H.; Hrbáček, Jan; Ali-El-Dein, Bedeir; Zaid, Harras B.; Schubert, Tina; Mischinger, Johannes; Todenhöfer, Tilman; Galland, Sigolene; Olugbade, Kola; Rink, Michael; Fritsche, Hans Martin; Burger, Maximilian; Chang, Sam S.; Babjuk, Marko; Thalmann, George N.; Stenzl, Arnulf; Morgan, Todd M.

doi:10.1159/000448335

Cited by 9 publications

(4 citation statements)

References 14 publications

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“…Recently published reports of cancer survival also confirmed the similar results. [ 20 , 21 ] In the present study, we found adjuvant chemotherapy was an important factor to improve OS in patients after RNU. Our oncological outcomes were in agreement with those of recent study series [ 22 ] but not in accordance with a cohort study in Korea.…”

Section: Discussionmentioning

confidence: 53%

Prognostic significance of urothelial carcinoma with divergent differentiation in upper urinary tract after radical nephroureterectomy without metastatic diseases

Qin

Liang²,

Du³

et al. 2017

Medicine

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To evaluate the impact of urothelial carcinoma with divergent differentiation (UCDD) on the prognosis of patients for primary upper urinary tract urothelial carcinoma (UTUC) with pN0/x status treated with radical nephroureterectomy (RNU) and to evaluate the prognostic value of UCDD in different tumor locations (renal pelvis and ureter).Data from a total of 346 patients with UTUC who received RNU between January 2012 and March 2016 in the institution were retrospectively analyzed. Clinicopathological features and prognostic factors age, sex, complaint, height, weight, blood pressure, tumor grade, stage, smoking status, history of adjuvant chemotherapy, tumor location, history of bladder cancer, tumor necrosis, degree of hydronephrosis, tumor size, tumor focality, and preoperative anemia were compared between patients with pure UTUC and patients with UCDD. The endpoints were cancer-specific survival (CSS), overall survival (OS), and intraluminal recurrence-free survival (IRFS).Overall, divergent differentiation was present in 50 patients (14.5%). UCDD was related to different tumor location (P = .01), smoking (P = .04), higher body mass index (P = .02), and advanced tumor grade (P = .01). By Kaplan–Meier analysis, UCDD was found to be significantly correlated with worse IRFS, CSS, and OS (all P < .01). Multivariate analysis demonstrated that UCDD was an independent predictor of IRFS (P < .01), CSS (P = .01), and OS (P = .01). However, 40 patients died for various reasons and the 5-year OS rates were 91.9% in UCDD− group and 68.0% in UCDD+ group, respectively. In patients with ureteral tumors, UCDD was the significant predictor for IRFS, CSS, and OS. However, the prognostic value of UCDD was not observed in pyelocaliceal tumors.The presence of divergent differentiation is associated with inferior survival. UCDD may identify patients at high risks for poor prognosis especially in patients with ureteral tumors. As a result, more attention and follow-up should be given to patients with ureteric urothelial carcinoma.

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Section: Discussionmentioning

confidence: 53%

Prognostic significance of urothelial carcinoma with divergent differentiation in upper urinary tract after radical nephroureterectomy without metastatic diseases

Qin

Liang²,

Du³

et al. 2017

Medicine

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“…After reviewing the titles, abstracts and full texts, we selected 92 studies for qualitative synthesis (Fig. 1) [1,2,4–6,8–95].…”

Section: Resultsmentioning

confidence: 99%

Urethral cancer: a comprehensive review endorsed by the Global Society of Rare Genitourinary Tumours

García‐Perdomo,

Dávila‐Raigoza,

Summers

et al. 2024

BJU International

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ObjectiveTo determine the effectiveness and adverse effects of urethrectomy alone or as part of multimodal therapy (MMT).MethodsA comprehensive search was conducted across MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) databases, from their inception to the present date. The study cohort comprised individuals aged 16 years and older diagnosed with urethral tumours at any stage who underwent either isolated urethrectomy or urethrectomy as an integral component of MMT.ResultsNinety‐two studies comprising 25 480 patients met the inclusion criteria. Surgical outcomes for urethral cancer vary considerably, with 5‐year overall survival (OS) ranging from 10% to 68% based on disease extent, approach, and gender. Radiotherapy (RT) alone provides 5‐year OS of approximately 40%. Combined regimens provide better outcomes compared to single modalities, including reduced recurrence and enhanced survival. However, trimodal therapy showed survival benefits only for urothelial subtypes, indicating the need to tailor management according to cancer type. MMT with neoadjuvant chemotherapy prior to surgery demonstrated the most consistent survival gains.ConclusionsThe management of urethral cancer demands a nuanced, personalised approach, accounting for factors such as tumour location, sex, and tumour stage. MMT combining surgery, chemotherapy and RT has shown the ability to enhance outcomes in advanced disease. More extensive collaborative studies through specialised centres are imperative to advance evidence‐based protocols and refine treatment in order to improve survival.

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“…Indeed, approximately 2-5% of patients with superficial and 40-60% with muscle-invasive bladder cancer develop urethral cancer later on [29]. In contrast, Gakis et al [30] reported one case (0.9%) of secondary bladder cancer 41 mo after initial therapy for PUC. Enlarged regional lymph nodes (LNs) are likely to represent metastatic disease (84%), making assessment of disease extent with pelvic magnetic resonance imaging for local staging obligatory [13,31,32].…”

Section: Diagnostic Evaluation and Stagingmentioning

confidence: 99%

Current Disease Management of Primary Urethral Carcinoma

Janisch

Abufaraj

Fajković

et al. 2019

European Urology Focus

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Context: Primary urethral cancer (PUC) is a rare cancer entity. Owing to the low incidence of this malignancy, the main body of literature consists mainly of case reports, making evidencebased management recommendations difficult. Objective: To review reported disease management strategies of PUC and their impact on oncological outcomes. Evidence acquisition: A systematic research was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement using Medline, Scopus, and Web of Science, to find studies of the past 10 yr including !20 patients, and investigating treatment strategies and their impact on outcomes of the three most frequent histologies: urothelial carcinoma, adenocarcinoma, and squamous cell carcinoma. Evidence synthesis: In localized PUC, penis-sparing surgery can be performed in males, while in females, complete urethrectomy with surrounding tissue is advised to minimize recurrence due to positive margins. Radiotherapy (RT) has worse survival and recurrence rates, as well as more adverse effects, than surgery, limiting its use in genital-preserving therapy. Locally advanced PUC should be treated with multimodal therapy, as monotherapies result in inferior recurrence and survival rates. Extent of surgery is still undecided, favoring radical cyst (oprostat)ectomy with total urethrectomy (RCU). Lymph node involvement is a predictor of survival, highlighting the role of lymph node dissection for disease control and staging. RT can improve survival in combination with surgery and/or chemotherapy (CHT). Neoadjuvant platinum-based CHT can improve overall and recurrence-free survival. At recurrence, salvage therapy with surgery and/or CHT can improve survival. Superficial urothelial carcinoma of the prostatic urethra can be treated with transurethral resection. Stromal invasion often features concomitant bladder cancer with a poor prognosis and requires RCU with or without systemic preoperative CHT. Conclusions: PUC is a rare malignancy with an often poor natural course, requiring a stageand gender-specific risk-based treatment strategy. The role of systematic perioperative CHT and the extent of surgery are becoming more important. Patient summary: In this review, we looked at the treatment options for primary urethral cancer. We found that while an organ-confined disease can be managed with local resection, growth beyond the organ border makes a combination of different treatment modalities, such as surgery and systematic chemotherapy, necessary to improve outcomes.

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Oncological Outcomes of Patients with Concomitant Bladder and Urethral Carcinoma

Cited by 9 publications

References 14 publications

Prognostic significance of urothelial carcinoma with divergent differentiation in upper urinary tract after radical nephroureterectomy without metastatic diseases

Prognostic significance of urothelial carcinoma with divergent differentiation in upper urinary tract after radical nephroureterectomy without metastatic diseases

Urethral cancer: a comprehensive review endorsed by the Global Society of Rare Genitourinary Tumours

Current Disease Management of Primary Urethral Carcinoma

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