627 Background: Primary urethral cancer is one of the rarest cancers worldwide, resulting in limited data and ongoing debates about the optimal standard of care. This study aimed to share our institutional experience in treating primary squamous cell carcinoma (SCC) of the urethra, the most common histologic subtype of urethral carcinoma. Methods: Utilizing an IRB-approved urethral cancer database, we conducted a retrospective review, identifying patients diagnosed with primary urethral carcinoma based on International Classification of Diseases codes (ICD-10: C-68 and ICD-9: 189.3). Codes related to “Secondary malignant neoplasm of other urinary organs” were also examined to ensure comprehensive patient identification. Data on patient demographics, baseline characteristics, treatments, and outcomes were extracted and analyzed. Results: We identified 68 patients with primary urethral cancer from August 1997 to September 2023, of whom 35 (51.5%) had primary SCC of the urethra. Baseline characteristics are summarized in Table 1. Among the 35 patients, 16 (45.7%) received neoadjuvant chemotherapy, with gemcitabine-based regimens being the most common (N=8), followed by TIP (paclitaxel, ifosfamide, and cisplatin) in 6 patients. Urethrectomy (N=12) was the most frequent surgical procedure, followed by penectomy and radical cystectomy. The median follow-up time was 2.4 years. Seventeen (48.6%) patients received adjuvant chemotherapy or immunotherapy, most commonly the TIP regimen (N=5, 29.4%) and pembrolizumab (N= 4, 23.5%). Additionally, 12 (34.3%) underwent adjuvant radiotherapy. The 5- year recurrence free survival and overall survival rates were 56.8%, and 93.8%, respectively. Of the 15 patients who developed secondary metastases, lymph nodes and regional genitourinary sites were the most frequent (each N=6), followed by the lungs (N=2) and bone (N=1). Conclusions: Our findings indicate that while the overall survival of primary urethral SCC patients is relatively favorable, there remains a lack of consensus regarding the standard of care for this malignancy. Additionally, despite the extended timeline of our study, the median follow-up duration was relatively short. These results highlight the need for larger multi-institutional studies with longer follow-up periods to establish a clearer standard of care for primary urethral cancer. Demographics and perioperative characteristics of the patients. Age (yrs.) 63.2 ± 13.4 Gender (Male) 26 (74.3%) Surgery of primary disease (N=31) Urethrectomy 12 (34.3%) Penectomy 8 (22.9%) Radical cystectomy 7 (20.0%) Other (mass excision, urethroplasty) 4 (11.4%) Primary Pathological staging (N=34) < (y) pT2N0 6 (20.0%) ≥ (y) pT2N0 17 (48.6%) pN+ 9 (25.7%) Metastatic 2 (5.7%)
Zahir et al. (Sun,) studied this question.