Advertisement

Association Between Perioperative Chemotherapy and Survival in Men Undergoing Radical Resection for Primary Urethral Urothelial Carcinoma: An Analysis of the National Cancer Database

Published:January 27, 2022DOI:https://doi.org/10.1016/j.clgc.2022.01.011

      Abstract

      Introduction

      The treatment landscape in invasive primary carcinoma of the urethra of urothelial histology closely aligns that of locally advanced urothelial carcinoma of the bladder. The survival benefit of perioperative chemotherapy for men undergoing radical surgery for primary urethral urothelial carcinoma (UUC) has not yet been well-elucidated.

      Patients and Methods

      Using the National Cancer Database (NCDB), we identified men diagnosed with non-metastatic invasive UUC (T2-4 N0-2 M0) from 2004 to 2016 treated with radical extirpative surgery. We compared OS between patients who had received peri-operative neoadjuvant (NAC) or adjuvant (AC) chemotherapy and those who had not using Kaplan-Meier curves and multivariable Cox proportional hazards regression model.

      Results

      A total of 191 patients met inclusion criteria. 113 patients (59.2%) did not receive chemotherapy, while 39 (20.4%) and 39 (20.4%) received NAC and AC, respectively. Median follow-up was 28.0 months. Upon multivariable analysis, receipt of NAC (HR 0.50, 95% CI 0.28-0.91, P = .02) decreased the risk of all-cause mortality, while receipt of AC (HR 0.76, 95% CI 0.41-1.41) was not significantly associated with an OS benefit, as compared to no chemotherapy.

      Conclusion

      Our study is the first to evaluate treatment specific outcomes in male patients with primary carcinoma of the urethra. We observed that neoadjuvant chemotherapy in men with UUC was associated with OS benefit. The utilization of NAC may improve survival, consistent with urothelial carcinoma of the bladder.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Genitourinary Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Visser O
        • Adolfsson J
        • Rossi S
        • et al.
        Incidence and survival of rare urogenital cancers in Europe.
        Eur J Cancer. 2012; 48: 456-464https://doi.org/10.1016/j.ejca.2011.10.031
        • Swartz MA
        • Porter MP
        • Lin DW
        • et al.
        Incidence of primary urethral carcinoma in the United States.
        Urology. 2006; 68: 1164-1168https://doi.org/10.1016/j.urology.2006.08.1057
        • Rabbani F.
        Prognostic factors in male urethral cancer.
        Cancer. 2011; 117: 2426-2434https://doi.org/10.1002/cncr.25787
        • Champ CE
        • Hegarty SE
        • Shen X
        • et al.
        Prognostic factors and outcomes after definitive treatment of female urethral cancer: a population-based analysis.
        Urology. 2012; 80: 374-382https://doi.org/10.1016/j.urology.2012.02.058
        • Grossman HB
        • Natale RB
        • Tangen CM
        • et al.
        Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer.
        N Engl J Med. 2003; 349: 859-866https://doi.org/10.1056/nejmoa022148
        • Flaig Tw
        • Spiess PE
        • Agarwal N
        • et al.
        Bladder cancer, version 3.2020, NCCN clinical practice guidelines in oncology.
        J Natl Compr Canc Netw. 2020; 18: 329-354https://doi.org/10.6004/jnccn.2020.0011
        • Dayyani F
        • Pettaway CA
        • Kamat AM
        • et al.
        Retrospective analysis of survival outcomes and the role of cisplatin-based chemotherapy in patients with urethral carcinomas referred to medical oncologists.
        Urol Oncol Semin Orig Investig. 2013; 31: 1171-1177https://doi.org/10.1016/j.urolonc.2012.01.011
        • Gakis G
        • Morgan TM
        • Daneshmand S
        • et al.
        Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma.
        Ann Oncol. 2015; 26: 1754-1759https://doi.org/10.1093/annonc/mdv230
        • Aleksic I
        • Rais-Bahrami S
        • Daugherty M
        • et al.
        Primary urethral carcinoma: a surveillance, epidemiology, and end results data analysis identifying predictors of cancer-specific survival.
        Urol Ann. 2018; 10: 170https://doi.org/10.4103/ua.ua_136_17
        • Cahn DB
        • Handorf E
        • Ristau BT
        • et al.
        Contemporary practice patterns and survival outcomes for locally advanced urethral malignancies: a National Cancer Database Analysis.
        Urol Oncol Semin Orig Investig. 2017; 35: 670.e15-670.e21https://doi.org/10.1016/j.urolonc.2017.07.026
        • Sui W
        • RoyChoudhury A
        • Wenske S
        • et al.
        Outcomes and prognostic factors of primary urethral cancer.
        Urology. 2017; 100: 180-186https://doi.org/10.1016/j.urology.2016.09.042
        • Reardon ZD
        • Patel SG
        • Zaid HB
        • et al.
        Trends in the Use of perioperative chemotherapy for localized and locally advanced muscle-invasive bladder cancer: a sign of changing tides.
        Eur Urol. 2015; 67: 165-170https://doi.org/10.1016/j.eururo.2014.01.009
        • Gakis G
        • Morgan TM
        • Efstathiou JA
        • et al.
        Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma.
        World J Urol. 2016; 34: 97-103https://doi.org/10.1007/s00345-015-1583-7
        • Dinney CP
        • Johnson DE
        • Swanson DA
        • et al.
        Therapy and prognosis for male anterior urethral carcinoma: an update.
        Urology. 1994; 43 (PMID: 8154072): 506-514https://doi.org/10.1016/0090-4295(94)90242-9
        • Bilimoria KY
        • Stewart AK
        • Winchester DP
        • et al.
        The national cancer data base: a powerful initiative to improve cancer care in the United States.
        Ann Surg Oncol. 2008; 15: 683-690https://doi.org/10.1245/s10434-007-9747-3
        • Gakis G
        • Witjes JA
        • Compérat E
        • et al.
        EAU guidelines on primary urethral carcinoma.
        Eur Urol. 2013; 64: 823-830https://doi.org/10.1016/j.eururo.2013.03.044
        • Cheville JC
        • Dundore PA
        • Bostwick DG
        • et al.
        Transitional cell carcinoma of the prostate: clinicopathologic study of 50 cases.
        Cancer. 1998; 82 (PMID: 9477103): 703-707
        • Humphrey PA
        • Moch H
        • Cubilla AL
        • et al.
        The 2016 WHO classification of tumours of the urinary system and male genital organs-Part B: prostate and bladder tumours.
        Eur Urol. 2016; 70: 106-119https://doi.org/10.1016/j.eururo.2016.02.028
      1. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration.
        Eur Urol. 2005; 48: 202-206https://doi.org/10.1016/j.eururo.2005.04.006
        • Grossman HB
        • Natale RB
        • Tangen CM
        • et al.
        Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer [published correction appears in N Engl J Med. 2003 Nov 6;349(19):1880].
        N Engl J Med. 2003; 349: 859-866https://doi.org/10.1056/NEJMoa022148
        • Pfail JL
        • Audenet F
        • Martini A
        • et al.
        Survival of patients with muscle-invasive urothelial cancer of the bladder with residual disease at time of cystectomy: A comparative survival analysis of treatment modalities in the National Cancer Database.
        Bladder Cancer. 2020; 6: 265-276https://doi.org/10.3233/BLC-200303