Eng Tony Y, Chen Tiffany W, Patel Abhilasha J, Vincent Jill N, Ha Chul S
Department of Radiation Oncology, University of Texas Health Science Center, San Antonio, TX.
Am J Clin Oncol. 2018 Sep;41(9):905-908. doi: 10.1097/COC.0000000000000391.
Urethral cancer is a rare malignancy, representing <1% of all malignancies. Optimal management, due to its rarity, presents as a treatment dilemma for physicians. There is a lack of consensus regarding treatment as large randomized trials cannot be performed; thus, optimal management decisions rely on study of retrospective cases. This is a review of our institutional experience with urethral cancer treated with various treatment modalities.
A retrospective chart review was performed on 31 patients treated for primary cancer of the urethra from 1958 to 2008. The patients were stratified by sex, histologic type, stage, date of diagnosis, type of treatment, and last follow-up. Early stage cases were designated as Tis-T2N0M0 and advanced cases were designated as T3-4, N+ or M+. Analysis was performed based on clinical stage, treatment modalities and outcomes.
Fourteen early stage cases and 17 advanced stage cases of urethral cancer were analyzed. The majority of early stage cases occurred in men (M:F=8:6) and the majority of advanced stage cases occurred in women (M:F=5:12). The most common histology was squamous cell carcinoma for both early and advanced stage cases. Surgery was the preferred modality of treatment for early stage cases (surgery used in 13 cases vs. chemo/radiotherapy used in 1 case) while for advanced cases, radiation ±chemotherapy was commonly used. Overall survival for this series was 45% at mean follow-up of 7 years. Eight of the 14 cases of early stage cancer remained disease free at last follow-up. Comparatively, only 5 of 17 with advanced cancers had no apparent disease at last follow-up. All but one of those patients were treated with combined modality therapy.
Patients with early stage urethral cancers do well with single modality therapy, whereas patients who present with advanced cancers may benefit from combined modality therapy. More extensive study is required to recommend a particular treatment protocol. However, in this rare malignancy, institutional experiences provide the best evidence currently due to the lack of multi-institutional trials.
尿道癌是一种罕见的恶性肿瘤，占所有恶性肿瘤的比例不到1%。由于其罕见性，最佳治疗方案给医生带来了治疗难题。由于无法进行大规模随机试验，因此在治疗方面缺乏共识；因此，最佳治疗决策依赖于对回顾性病例的研究。这是对我们机构采用各种治疗方式治疗尿道癌的经验回顾。
对1958年至2008年期间接受原发性尿道癌治疗的31例患者进行回顾性病历审查。患者按性别、组织学类型、分期、诊断日期、治疗类型和最后随访情况进行分层。早期病例定义为Tis-T2N0M0，晚期病例定义为T3-4、N+或M+。根据临床分期、治疗方式和结果进行分析。
分析了14例早期尿道癌病例和17例晚期尿道癌病例。大多数早期病例发生在男性（男:女 = 8:6），大多数晚期病例发生在女性（男:女 = 5:12）。早期和晚期病例最常见的组织学类型均为鳞状细胞癌。手术是早期病例的首选治疗方式（13例采用手术，1例采用化疗/放疗），而晚期病例通常采用放疗±化疗。该系列患者的总生存率在平均随访7年时为45%。14例早期癌症病例中有8例在最后随访时无疾病复发。相比之下，17例晚期癌症患者中只有5例在最后随访时无明显疾病。除1例患者外，所有这些患者均接受了联合治疗。
早期尿道癌患者采用单一治疗方式效果良好，而晚期癌症患者可能从联合治疗中获益。需要进行更广泛的研究以推荐特定的治疗方案。然而，在这种罕见的恶性肿瘤中，由于缺乏多机构试验，机构经验目前提供了最好的证据。
