Abstract: PD49-11
Sources of Funding: none

Introduction

Primary urethral cancers account for less than 1% of all GU cancers. Due to the rarity of this condition, the literature is limited to retrospective case series and case reports. Therefore we sought to characterize female urethral cancer in a contemporary cohort.

Methods

Years 2004?2013 of the National Cancer Database (NCDB) were used to identify primary urethral neoplasms among women. Clinicopathologic variables including age, race, tumor histology, grade, and treatment modality were analyzed. Overall survival (OS) was estimated using the Kaplan-Meier method. Associations with survival were evaluated using Cox regression models.

Results

Between 2004 and 2013 there were 1,088 cases of primary female urethral cancer in NCDB. The median age at diagnosis was 66 years (IQR 56, 77) and the majority of women were Caucasian (66%) or African-American (30%). Adenocarcinoma (AC) was the most common histologic subtype (34%), followed by squamous (SCC) (26%) and urothelial cell carcinoma (UC) (25%). Women with AC were younger (63 years vs 69 for UC and 67 for SCC, p<0.001) and more likely to be African American (56.0 % vs 24.2%, p<0.001). _x000D_ At diagnosis 45% of all patients were ≥cT3 and 38% were clinical stage III or higher. 16.6% had clinical node positive disease while 8.8% had distant metastatic disease. Among those with AC 56.8% were ≥cT3 compared to 48.2% of SCC and 35% with UC (p<0.001). Patients with AC were most likely to undergo definitive surgery (72% vs 68% for UC and 59% for SCC, p=0.0067). Conversely, those with SCC were more likely to be treated with primary chemo-radiation (16% vs 7% of AC and 5% of UC, p<0.0001). Nearly 44% of patients with SCC received radiation therapy during treatment compared to 37% and 21% of AC and UC patients respectively (p<0.0001). _x000D_ Median survival for those living was 47 months while 5 year OS was 41%. By subtype, 5 year OS for AC was worse than SCC or UC (Figure 1) (Log-Rank 0.013). On multivariate analysis, after adjusting for clinical TNM stage, race, age, and treatment modality, histology was no longer significantly associated with overall survival (p=0.57)._x000D_

Conclusions

Patients with AC are younger, more likely to be African American, and present at a later stage than those with SCC or UC. Five year overall survival is poor regardless of histology, but worse among those with AC.

Funding

none