Cahn DB, et al. – The physicians conducted this work to determine practice patterns and survival outcomes for locally advanced urethral cancers. Despite a survival benefit, most patients with locally advanced PUC do not undergo definitive multimodal therapy. They suggest for a multidisciplinary–based treatment technique for these patients. Future prospective trials of multimodal therapy are crucial.

Methods

• Researchers queried National Cancer Database for patients with T2–4 or N1–2M0 PUC with urothelial, squamous, or adenocarcinoma histology from 2004 to 2013.
• They evaluated temporal trends for receipt of local or definitive surgery, radiotherapy (XRT), and systemic therapy.
• Adjusting for clinicopathologic characteristics, they assessed the impact of tumor stage and histology on receipt of definitive multimodal therapy (cystectomy + chemotherapy ± XRT) and effects of treatment on overall survival.

Results

• Researchers enrolled a sum of 1,749 patients as an inclusion criteria (22.2% adenocarcinoma, 29.3% squamous, and 48.5% urothelial).
• They demonstrated that only 29.6% underwent cystectomy ± XRT, and 15.6% underwent definitive multimodal therapy.
• In context of the data, following adjustment, older patients (age 50–75: odds ratio [OR] = 0.42 [95% CI: 0.28–0.63]; age 75+: OR = 0.06 [95% CI: 0.03–0.13]) and those with squamous histology (OR = 0.46 [95% CI: 0.3–0.7]) were less likely to receive definitive multimodal therapy.
• The obtained data indicate that more advanced stage (T3: OR = 1.66 [95% CI: 1.15–2.41]; T4: OR = 3.57 [95% CI: 2.47–5.16]); and N2 status (OR = 1.88 [95% CI: 1.27–2.78]) were more likely to receive definitive multimodal therapy.
• Importantly, an overall survival benefit was only found with definitive multimodal therapy for PUC of urothelial origin (hazard ratio = 0.61 [95% CI: 0.45–0.83]).