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Carcinoma of the Urethra in Women
1716
PRINCIPLES OF ONCOLOGY, AND TUMORS OF BLADDER, PENIS AND URETHRA
Carcinoma of the Urethra in Women
P. W. GRICSBY, Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School o f Medicine, St. Louis, Missouri Int. J. Rad. Oncol. Biol. Phys.. 41: 535-541, 1998 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 of44 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, T 3 in 22, and T4 in nine. Treatment was with surgery in I , radiotherapy in 25, a n d combined surgery and radiotherapy in 12. Results: The 5-year overall survival was 42% and the &year cause-specific survival w a s 40% At t h e time of last follow-up, 11 women were alive and 33 were dead. Recurrence of tumor occurred in 27 women a n d was t h e 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 ( 2 0 4 ) . The severe complication rate was 29% ( 2 of 7) for women treated with surgery, 2 4 4 (6of 25) for women treated with radiotherapy, and 8%(1of 12) for women treated with surgery and radiotherapy. A multivariate analysis was performed to evaluate the interaction of tumor size, histology, and location, a n d 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 1of 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, a n d only one woman with a tumor greater than 4 cm w a s alive at 5 years, irrespective of modality of treatment. Aggressive treatment resulted in a high complication rate. Editorial Comment: The authors review the clinical presentations of primary carcinoma of the urethra in women, and describe the tumor characteristics (predominantly histological type and size), and staging of disease, since these are associated with prognosis. In this context the various types of treatment (external radiation, brachytherapy or surgery) and the results are reviewed. This study has many weaknesses. It is a retrospective review based on clinical records and pathology reports rather than a review of the original material. Furthermore, followup evaluation is based on radiotherapy records, hospital charts, referring physicians, death certificates and occasionally from relatives of the patients. None of these provides any assurance as to the accuracy of analysis, and each may have reflected selection biases that could have influenced reported results. Thus, 27 of 33 patients had recurrent disease with 5-year overall survival and 5-year cause specific survival of 42 and 40%, respectively. Tumor size was a prognostic factor and probable treatment selection factor with nearly 90% of women with tumors less than 2 em. surviving for 5 years compared to 1% for women with tumors greater than 4 cm. Location of the tumor at the distal urethra provided a more optimum prognosis than those with tumors of the proximal or entire urethra (61 versus l%), while twice as many patients with squamous cell carcinoma survived 5 years compared with those with transitional cell cancer (62 versus 309'0). A report such as this does little to advance our knowledge as to assessment and treatment other than to indicate that there are substantial selection factors involved in how to approach the management of these unusual but often devastating conditions. Michael J. Droller, M.D.
Biomarker Study of Primary Nonmetastatic Versus Metastatic Invasive Bladder Cancer
P. LIANES,E. CHARYTONOWICZ, C. CORDON-CARDO, Y. FRADET, H. B. GROSSMAN, G. P. HEMSTREET, F. M. WALDMAN, K. CHEW,L. L. WHEELESS, D. FARACCI AND THE NATIONAL CANCERINSTITUTE BIADDERTUMOR MARKER NETWORK, Departments of Pathology, Memorial Sloan-Kettering Cancer Center, New York and University o f Rochester, Rochester, New York, Department of Urology, Lava1 University, Laual, Quebec, Canada, Universify of Texas M. D.Anderson Cancer Center, Houston, Texas, Department of Urology, University o f Okfahoma Health Sciences Center, Oklahoma City, Oklahoma, Division of Molecular Cytometry, University of California, San Francisco, California, and Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, Maryland Clin. Cancer Res., 4: 1267-1271, 1998 A cohort of 109 patients with primary transitional cell carcinomas, stages T,-T,, grade 2 or higher, w a s identified a n d further divided into two groups based on lymphatic metastasis a t the time of cystectomy (n = 57 cases) or absence of detectable metastatic disease over a minimum of 5 years of follow-up after cystectomy ( n = 52). Blocks corresponding to the primary tumor lesions were sectioned and distributed to different laboratories to be analyzed. Immunohistochemistry on deparafinized tissue sections was conducted for
PRINCIPLES OF ONCOLOGY, AND TUMORS OF BLADDER, PENIS AND URETHRA
Carcinoma of the Urethra in Women
P. W. GRICSBY, Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School o f Medicine, St. Louis, Missouri Int. J. Rad. Oncol. Biol. Phys.. 41: 535-541, 1998 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 of44 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, T 3 in 22, and T4 in nine. Treatment was with surgery in I , radiotherapy in 25, a n d combined surgery and radiotherapy in 12. Results: The 5-year overall survival was 42% and the &year cause-specific survival w a s 40% At t h e time of last follow-up, 11 women were alive and 33 were dead. Recurrence of tumor occurred in 27 women a n d was t h e 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 ( 2 0 4 ) . The severe complication rate was 29% ( 2 of 7) for women treated with surgery, 2 4 4 (6of 25) for women treated with radiotherapy, and 8%(1of 12) for women treated with surgery and radiotherapy. A multivariate analysis was performed to evaluate the interaction of tumor size, histology, and location, a n d 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 1of 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, a n d only one woman with a tumor greater than 4 cm w a s alive at 5 years, irrespective of modality of treatment. Aggressive treatment resulted in a high complication rate. Editorial Comment: The authors review the clinical presentations of primary carcinoma of the urethra in women, and describe the tumor characteristics (predominantly histological type and size), and staging of disease, since these are associated with prognosis. In this context the various types of treatment (external radiation, brachytherapy or surgery) and the results are reviewed. This study has many weaknesses. It is a retrospective review based on clinical records and pathology reports rather than a review of the original material. Furthermore, followup evaluation is based on radiotherapy records, hospital charts, referring physicians, death certificates and occasionally from relatives of the patients. None of these provides any assurance as to the accuracy of analysis, and each may have reflected selection biases that could have influenced reported results. Thus, 27 of 33 patients had recurrent disease with 5-year overall survival and 5-year cause specific survival of 42 and 40%, respectively. Tumor size was a prognostic factor and probable treatment selection factor with nearly 90% of women with tumors less than 2 em. surviving for 5 years compared to 1% for women with tumors greater than 4 cm. Location of the tumor at the distal urethra provided a more optimum prognosis than those with tumors of the proximal or entire urethra (61 versus l%), while twice as many patients with squamous cell carcinoma survived 5 years compared with those with transitional cell cancer (62 versus 309'0). A report such as this does little to advance our knowledge as to assessment and treatment other than to indicate that there are substantial selection factors involved in how to approach the management of these unusual but often devastating conditions. Michael J. Droller, M.D.
Biomarker Study of Primary Nonmetastatic Versus Metastatic Invasive Bladder Cancer
P. LIANES,E. CHARYTONOWICZ, C. CORDON-CARDO, Y. FRADET, H. B. GROSSMAN, G. P. HEMSTREET, F. M. WALDMAN, K. CHEW,L. L. WHEELESS, D. FARACCI AND THE NATIONAL CANCERINSTITUTE BIADDERTUMOR MARKER NETWORK, Departments of Pathology, Memorial Sloan-Kettering Cancer Center, New York and University o f Rochester, Rochester, New York, Department of Urology, Lava1 University, Laual, Quebec, Canada, Universify of Texas M. D.Anderson Cancer Center, Houston, Texas, Department of Urology, University o f Okfahoma Health Sciences Center, Oklahoma City, Oklahoma, Division of Molecular Cytometry, University of California, San Francisco, California, and Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, Maryland Clin. Cancer Res., 4: 1267-1271, 1998 A cohort of 109 patients with primary transitional cell carcinomas, stages T,-T,, grade 2 or higher, w a s identified a n d further divided into two groups based on lymphatic metastasis a t the time of cystectomy (n = 57 cases) or absence of detectable metastatic disease over a minimum of 5 years of follow-up after cystectomy ( n = 52). Blocks corresponding to the primary tumor lesions were sectioned and distributed to different laboratories to be analyzed. Immunohistochemistry on deparafinized tissue sections was conducted for