title: Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, University of Tübingen, Tübingen, Germany. georgios.gakis@web.de.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Efstathiou
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Keegan
authors.affiliation: Department of Urology, University of Tübingen, Tübingen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mischinger
authors.affiliation: Department of Urology, University of Tübingen, Tübingen, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhoefer
authors.affiliation: Department of Urology, University of Tübingen, Tübingen, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Schubert
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Harras B
authors.initials: HB
authors.lastname: Zaid
authors.affiliation: Department of Urology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Hrbacek
authors.affiliation: Mansoura Clinic, Urology and Nephrology Center, Mansoura, Egypt.
authors.forename: Bedeir
authors.initials: B
authors.lastname: Ali-El-Dein
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Clayman
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sigolene
authors.initials: S
authors.lastname: Galland
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kola
authors.initials: K
authors.lastname: Olugbade
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.affiliation: Department of Urology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.affiliation: Department of Urology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Department of Urology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Marko
authors.initials: M
authors.lastname: Babjuk
authors.affiliation: Department of Urology, University Hospital Berne, Berne, Switzerland.
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.affiliation: Department of Urology, University of Tübingen, Tübingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: USC/Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA, USA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014523:Urethral Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
keywords: Clinical; Nodal stage; Primary urethral carcinoma; Prognostic; Risk factors; Survival