Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press200310.17650/1726-9776-2026-22-1-104-119REVIEWSОБЗОРЫReview ArticleSurvival rates in primary urethral cancer: systematic review and meta-analysisВыживаемость при первичном раке уретры: систематический обзор и метаанализhttps://orcid.org/0000-0003-3285-5559VorobevVladimir A.ВоробьевВладимир Анатольевич
Russian Federation
denecer@yandex.ruhttps://orcid.org/0000-0002-8461-9243IzmailovA. A.ИзмайловА. А.
Russian Federation
denecer@yandex.ruhttps://orcid.org/0009-0005-4019-9602FarganovA. R.ФаргановА. Р.
Russian Federation
denecer@yandex.ruhttps://orcid.org/0009-0005-9143-916XSu-YanzK. M.Су-ЯнзК. М.
Russian Federation
denecer@yandex.ruhttps://orcid.org/0009-0003-0616-3257SyrovaA. I.СыроваА. И.
Russian Federation
denecer@yandex.ruhttps://orcid.org/0009-0001-9400-1738SyrovaA. I.СыроваА. И.
Russian Federation
denecer@yandex.ruBashkir State Medical University, Ministry of Health of RussiaФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава РоссииIrkutsk State Medical University, Ministry of Health of RussiaФГБОУ ВО «Иркутский государственный медицинский университет» Минздрава РоссииRepublican Clinical Oncology DispensaryГАУЗ «Республиканский клинический онкологический диспансер» Минздрава Республики БашкортостанRepublican Clinical Oncology Dispensary, Republic of BashkortostanГАУЗ «Республиканский клинический онкологический диспансер» Минздрава Республики Башкортостан100720262211041190301202627022026Copyright ©; 2026, ABV-PressCopyright ©; 2026, АБВ-пресс2026ABV-PressАБВ-прессhttps://creativecommons.org/licenses/by/4.0/https://oncourology.abvpress.ru/oncur/article/view/2003

Background. Primary urethral carcinoma is a rare and aggressive malignancy of the genitourinary system characterized by significant heterogeneity and limited high-quality evidence.

Aim. To summarize survival outcomes and identify key prognostic factors.

Materials and methods. A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and eLibrary was performed according to PRISMA 2020 guidelines. Eligible studies (2000–2025) included ≥5 patients with primary urethral cancer and reported overall (OS) and/or cancer-specific survival (CSS). Thirty studies (n = 12,215) met the inclusion criteria. A random-effects meta-analysis was conducted.

Results. The pooled 5-year OS was 44.8 % (95 % confidence interval 41.5–48.1, I2 = 74 %), while 5-year CSS was approximately 51.5 % (95 % confidence interval 45.8–57.2, I2 = 88.7 %). Localized disease showed markedly better outcomes, with OS reaching 60–70 % in non-metastatic cases. Regional nodal involvement reduced survival to 30–40 %, and distant metastases to < 10 %. Radical surgery (partial/total urethrectomy and possible lymph node dissection) was associated with a 50–60 % reduction in mortality compared to non-surgical management. Histological subtype impacted prognosis: urothelial and squamous cell carcinomas showed comparable outcomes, whereas adenocarcinoma and melanoma demonstrated significantly poorer CSS.

Conclusion. Findings emphasize the critical importance of early detection and radical surgical treatment. High rates of local recurrence after organ-sparing approaches highlight the need for multimodal therapy. Despite advances in combined treatment strategies, long-term outcomes remain suboptimal, supporting further research into optimized therapeutic sequencing and novel systemic agents.

Введение. Первичный рак уретры представляет собой редкое и агрессивное новообразование мочеполовой системы с выраженной клинической вариабельностью и ограниченной доказательной базой.

Цель систематического обзора и метаанализа – оценить долгосрочную выживаемость пациентов и определить ключевые прогностические факторы.

Материалы и методы. Поиск проводился в базах PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library и eLibrary в соответствии с PRISMA 2020. Включались исследования, опубликованные с 2000 по 2025 г., содержащие ≥5 случаев первичного рака уретры и данные по общей (ОВ) и/или раковоспецифической выживаемости. После многоэтапного отбора включено 30 исследований. Выполнен метаанализ с использованием модели случайных эффектов.

Результаты. Сводная 5-летняя ОВ составила 44,8 % (95 % доверительный интервал 41,5–48,1, I2 = 74 %), 5-летняя раковоспецифическая выживаемость – 51,5 % (95 % доверительный интервал 45,8–57,2, I2 = 88,7 %). Локализованная стадия ассоциировалась с существенно лучшим прогнозом, так как ОВ достигала 60–70 % при отсутствии M1. При регионарных метастазах выживаемость снижалась до 30–40 %, а при M1 составила менее 10 %. Радикальная хирургия (частичная/тотальная уретрэктомия с лимфаденэктомией или без нее) снижала риск смерти на 50–60 % по сравнению с нехирургической тактикой. Гистологический тип влиял на исходы: при уротелиальном и плоскоклеточном раке отмечали сопоставимую выживаемость, тогда как при аденокарциноме и меланоме – худшие результаты.

Заключение. Полученные данные подчеркивают решающее значение ранней диагностики и радикального хирургического лечения. Высокая частота местных рецидивов после органосохраняющих подходов свидетельствует о необходимости мультимодальной терапии. Несмотря на прогресс комбинированных методов, отдаленные результаты остаются неудовлетворительными, что обосновывает необходимость разработки новых системных стратегий.

urethral carcinomasurvivalmeta-analysisPRISMAsurgeryprognostic factorрак уретрывыживаемостьметаанализPRISMAхирургическое лечениепрогностический факторVisser O., van der Zwan J.M., van Leeuwen F.E. et al. Incidence and survival of rare urogenital cancers in Europe. Eur J Cancer 2012;48(4):456–64. DOI: 10.1016/j.ejca.2011.10.031Cheng S.F., Veenema R.J. Topical application of thio-tepa to penile and female urethral carcinoma. J Urol 1965;93:515–22. DOI: 10.1016/S0022-5347(17)63611-5Grabstald H., Sherman A.B., Schoenberg H.W. et al. Cancer of the female urethra. J Urol 1966;95(5):766–73.Лифшиц Б.С., Нечипоренко Н.А. О первичном раке мужской уретры. Вестник хирургии 1969;8:45–8. Lifshitz B.S., Nechiporenko N.A. On primary cancer of the male urethra. Vestnik khirurgii = Bulletin of Surgery 1969;8:45–8. (In Russ.).Sawczuk I., Shapiro C.E., Boretz D., Brown J. Post urethroplasty squamous cell carcinoma. N Y State J Med 1986;86(5):261–2.Mohanty N.K., Jolly B.B., Saxena S. et al. Squamous cell carcinoma of perineal urethrostomy. Urologia Int 1995;55(2):118–20. DOI: 10.1159/000282765Wiener J.S., Walsh P.C., Eisenberger M.A. et al. Oncogenic human papillomavirus type 16 is associated with squamous cell cancer of the male urethra. Cancer Res 1992;52(17):5018–23.Cupp M.R., Malek R.S., Goellner J.R., Oesterling J.E. Detection of human papillomavirus DNA in primary squamous cell carcinoma of the male urethra. Urology 1996;48(4):551–5. DOI: 10.1016/S0090-4295(96)00246-4Thomas A.A., Rackley R.R., Lee U. et al. Urethral diverticula in 90 female patients: a study with emphasis on neoplastic alterations. J Urol 2008;180(6):2463–7. DOI: 10.1016/j.juro.2008.08.040Матвеев В.Б., Гриднева Я.В. Результаты комбинированного и лучевого лечения рака уретры. Вестник Российского онкологического научного центра 2006;17(1):43–7. Matveev V.B., Gridneva Y.V. Results of combined and radiation therapy of urethral cancer. Vestnik Rossiiskogo onkologicheskogo nauchnogo tsentra = Bulletin of the Russian Oncology Research Center 2006;17(1):43–7. (In Russ.).Peyton C.C., Azizi M., Chipollini J. et al. Survival Outcomes Associated With Female Primary Urethral Carcinoma: Review of a Single Institutional Experience. Clin Genitourin Cancer 2018;16(5):e1003–13. DOI: 10.1016/j.clgc.2018.05.012Page M.J., McKenzie J.E., Bossuyt P.M. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: 10.1136/bmj.n71Milosevic M.F., Blend R., Panzarella T. et al. Urethral carcinoma in women: results of treatment with primary radiotherapy. Radiother Oncol 2000;56(1):29–35. DOI: 10.1016/S0167-8140(00)00208-5DiMarco D.S., DiMarco C.S., Zincke H. et al. Surgical treatment for local control of female urethral carcinoma. Urol Oncol 2004;22(5):404–9. DOI: 10.1016/S1078-1439(03)00174-1DiMarco D.S., DiMarco C.S., Zincke H. et al. Outcome of surgical treatment for primary malignant melanoma of the female urethra. J Urol 2004;171(2 Pt 1):765–7. DOI: 10.1097/01.ju.0000104671.20863.47Thyavihally Y.B., Tongaonkar H.B., Srivastava S.K. et al. Clinical outcome of 36 male patients with primary urethral carcinoma: a single center experience. Int J Urol 2006;13(6):716–20. DOI: 10.1111/j.1442-2042.2006.01392.xAbudurexiti M., Wang J., Shao N. et al. Prognosis of rare pathological primary urethral carcinoma. Cancer Manag Res 2018;10:6815–22. DOI: 10.2147/CMAR.S184197Rabbani F., Leonard M.P., Golabek T. et al. Prognostic factors in male urethral cancer (analysis of SEER data). Cancer 2011;117(11):2426–34. DOI: 10.1002/cncr.25787Gakis G., Morgan T.M., Daneshmand S. et al. Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma. Ann Oncol 2015;26(8):1754–9. DOI: 10.1093/annonc/mdv230Greskovich F.J., Purdy L., Attwood K. et al. Definitive radiation therapy for urethral carcinoma: retrospective review of outcome and toxicity. Urology 2013;81(5):1191–5.Champ C.E., Hegarty S.E., Shen X. et al. Prognostic factors and outcomes after definitive treatment of female urethral cancer: a population-based analysis. Urology 2012;80(2):374–81. DOI: 10.1016/j.urology.2012.02.058Derksen J.W., Visser O., de la Rivière G.B. et al. Primary urethral carcinoma in females: an epidemiologic study on demographical factors, histological types, tumour stage and survival. World J Urol 2013;31(1):147–53. DOI: 10.1007/s00345-012-0882-5Cohen M.S., Triaca V., Billmeyer B. et al. Coordinated chemoradiation therapy with genital preservation for the treatment of primary invasive carcinoma of the male urethra. J Urol 2008;179(2):536–41. DOI: 10.1016/j.juro.2007.09.068Eng T.Y., Naguib M., Galang T., Fuller C.D. Retrospective study of the treatment of urethral cancer. am j clin oncol 2003;26(6): 558–62. DOI: 10.1097/01.COC.0000037764.72722.07Dayyani F., Pettaway C.A., Kamat A.M. et al. Retrospective analysis of survival outcomes and the role of cisplatin-based chemotherapy in patients with urethral carcinomas referred to medical oncologists. Urol Oncol 2013;31(7):1171–7. DOI: 10.1016/j.urolonc.2012.01.011Dayyani F., Hoffman K., Eifel P. et al. Management of advanced primary urethral carcinomas. BJU Int 2014;114(1):25–31. DOI: 10.1111/bju.12630Itoh J., Mitsuzuka K., Kimura S. et al. Docetaxel, cisplatin and 5-fluorouracil chemotherapy with concurrent radiation for unresectable advanced urethral carcinoma. Int J Urol 2014;21(4):422–4. DOI: 10.1111/iju.12333Kent M., Zinman L., Girshovich L. et al. Combined chemoradiation as primary treatment for invasive male urethral cancer. J Urol 2015;193(2):532–7. DOI: 10.1016/j.juro.2014.07.105Gakis G., Morgan T.M., Efstathiou J.A. et al. Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma. World J Urol 2016;34(1):97–103. DOI: 10.1007/s00345-015-1583-7Cahn D.B., Handorf E., Ristau B.T. et al. Contemporary practice patterns and survival outcomes for locally advanced urethral malignancies: A National Cancer Database Analysis. Urol Oncol 2017;35(12):670.e15–21. DOI: 10.1016/j.urolonc.2017.07.026Sui W., Miller E.D., Whang G. et al. Outcomes and prognostic factors of primary urethral cancer. Urology 2017;100:180–6. DOI: 10.1016/j.urology.2016.09.042Kang M., Jeong C.W., Kwak C. et al. Survival Outcomes and Predictive Factors for Female Urethral Cancer: Long-term Experience with Korean Patients. J Korean Med Sci 2015;30(8):1143–9. DOI: 10.3346/jkms.2015.30.8.1143Nazzani S., Faisal F.A., Sourial M.W. et al. Prognostic determinants in patients with primary urethral carcinoma: a population-based study. Int J Urol 2017;24(2):111–6.Eng T.Y., Chen T.W., Patel A.J. et al. Treatment and Outcomes of Primary Urethra Cancer. Am J Clin Oncol 2018;41(9):905–8. DOI: 10.1097/COC.0000000000000391Son C.H., Liauw S.L., Hasan Y. et al. Optimizing the Role of Surgery and Radiation Therapy in Urethral Cancer Based on Histology and Disease Extent. Int J Radiat Oncol Biol Phys 2018;102(2):304–13. DOI: 10.1016/j.ijrobp.2018.05.011Abudurexiti M., Wang J., Shao N. et al. Prognosis of rare pathological primary urethral carcinoma. Cancer Manag Res 2018;10:6815–22. DOI: 10.2147/CMAR.S184197Werntz R.P., Riedinger C.B., Fantus R.J. et al. The role of inguinal lymph node dissection in men with urethral squamous cell carcinoma. Urol Oncol 2018;36(12):526.e1–6. DOI: 10.1016/j.urolonc.2018.09.014Aleksic I., Hudson M.A., Djebbar T. et al. Primary urethral carcinoma: a SEER data analysis identifying predictors of cancer-specific survival. Urol Ann 2018;10(2):170–4. DOI: 10.4103/UA.UA_136_17Mano R., Vertosick E.A., Sarcona J. et al. Primary urethral cancer: treatment patterns and associated outcomes. BJU Int 2020;126(3):359–66. DOI: 10.1111/bju.15095Stone B.V., Hill S.C., Moses K.A. The effect of centralization of care on overall survival in primary urethral cancer. Urol Oncol 2021;39(2):133.e17–26. DOI: 10.1016/j.urolonc.2020.09.020Wu J., Wang Y.C., Luo W.J. et al. Primary tumor surgery improves survival in non-metastatic primary urethral carcinoma patients: a large population-based investigation. BMC Cancer 2021;21:857.Oliva E., Quade B.J., Dover G.J. et al. Primary malignant melanoma of the urethra: a clinicopathologic analysis of 15 cases. Am J Surg Pathol 2000;24(6):785–96. DOI: 10.1097/00000478-200006000-00003Van der Zwan A.J., van Dijk M.R., Willemse P.H. et al. Melanoma of the penis, scrotum and male urethra: a clinical analysis of 19 cases. Urology 2005;65(3):593–7.Гриднева Я.В. Меланома уретры (клиническое наблюдение и обзор литературы). Онкоурология 2005;(1):40–2. Gridneva Ya.V. Melanoma of the urethra (clinical observation and literature review). Onkourologiya = Cancer Urology 2005;(1):40–2. (In Russ.).Deng H., Zhang J., Alam R. et al. Novel association of RAD54L mutation with Müllerian adenocarcinoma of urethra: comprehensive genomic profiling of a case. JCO Precis Oncol 2024,8:e2200504.Guyatt G.H., Oxman A.D., Vist G.E. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924–6. DOI: 10.1136/bmj.39489.470347.ADWu J., Wang Y.C., Luo W.J. et al. Primary tumor surgery improves survival in non-metastatic primary urethral carcinoma patients: a large population-based investigation. BMC Cancer 2021;21:857.