Carcinoma of the urethra in women

Purpose: This analysis was performed to evaluate the influence of clinical and treatment factors on local tumor control, survival, and complications for women with urethral carcinoma. Methods and Materials: The records of 44 women with carcinoma of the urethra were reviewed. Their age ranged from 37 to 89 years (mean, 67 years). Mean follow-up time was 8.25 years. The stages of disease were T1 in eight, T2 in five, T3 in 22, and T4 in nine. Treatment was with surgery in 7, radiotherapy in 25, and combined surgery and radiotherapy in 12. Results: The 5-year overall survival was 42% and the 5-year cause-specific survival was 40%. At the time of last follow- up, 11 women were alive and 33 were dead. Recurrence of tumor occurred in 27 women and was the cause of death for 23. Recurrence was local in 8, local and distant in 15, and distant in 4. Severe complications occurred in nine women (20%). The severe complication rate was 29% (2 of 7) for women treated with surgery, 24% (6 of 25) for women treated with radiotherapy, and 8% (1 of 12) for women treated with surgery and radiotherapy. A multivariate analysis was performed to evaluate the interaction of tumor size, histology, and location, and lymph node status. This analysis indicated that tumor size and histology were independent prognostic factors for survival and local tumor control. Adenocarcinoma occurred in 13 women, and none of them were alive at 5 years. Only 1 of 10 women with tumors greater than 4 cm was alive at 5 years. Conclusions: The most significant clinical factors affecting prognosis were tumor size and histology. Tumor location was not an independent prognostic variable. None of the women with adenocarcinoma, and only one woman with a tumor greater than 4 cm was alive at 5 years, irrespective of modality of treatment. Aggressive treatment resulted in a high complication rate.