International Urology and Nephrology

, Volume 52, Issue 1, pp 51–57 | Cite as

The epidemiology and role of surgery in the treatment of urethral clear cell carcinoma

  • Mausam Patel
  • Jay Im
  • Austin Ivy
  • Sanjay Maraboyina
  • Thomas KimEmail author
Urology - Original Paper



To perform a retrospective analysis of the epidemiology and role of surgery on survival in patients with urethral clear cell carcinoma (UCCC) using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database.


UCCC cases diagnosed from January 1, 1973, to December 31, 2014, were extracted from SEER. Descriptive statistics were calculated for all variables. Univariate analysis to assess for differences in survival with respect to covariates was performed using the log-rank test. Multivariate analysis was performed with Cox proportional hazards regression models to determine the predictive performance of covariates with respect to overall survival (OS) and disease-specific survival (DSS), reported as hazard ratio (HR) with 95% CIs. Comparisons were considered statistically significant at P < 0.05.


Sixty-one cases were extracted for analysis. Mean age ± SD was 63.0 ± 13.9 years. Fifty (82%), 18 (29.5%), and 14 (23.0%) patients underwent surgery, radiation, and chemotherapy, respectively. On univariate analysis, the following covariates were associated with both OS and DSS: age, stage, and surgery (all P < 0.001). On multivariate analysis, surgery was a predictor for improved OS and DSS (HR, 0.178; 95% CI [0.068; 0.464]) and HR, 0.166; 95% CI [0.057; 0.484], respectively). Neither radiation nor chemotherapy was significantly associated with OS or DSS.


Surgery was associated with improved OS and DSS in patients with UCCC. While neither radiation nor chemotherapy was significantly associated with survival, additional studies are necessary to determine how these therapeutic interventions may impact prognosis.


Urethra Clear cell SEER Epidemiology Survival 



No funding was provided for this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Mehra R et al (2014) Primary urethral clear-cell adenocarcinoma: comprehensive analysis by surgical pathology, cytopathology, and next-generation sequencing. Am J Pathol 184(3):584–591CrossRefGoogle Scholar
  2. 2.
    Clayton M, Siami P, Guinan P (1992) Urethral diverticular carcinoma. Cancer 70(3):665–670CrossRefGoogle Scholar
  3. 3.
    Evans KJ, McCarthy MP, Sands JP (1981) Adenocarcinoma of a female urethral diverticulum: case report and review of the literature. J Urol 126(1):124–126CrossRefGoogle Scholar
  4. 4.
    Niemiec TR et al (1989) Unusual urethral diverticulum lined by colonic epithelium with Paneth cell metaplasia. Am J Obstet Gynecol 160(1):186–188CrossRefGoogle Scholar
  5. 5.
    Eble JN et al (2004) Pathology and genetics of tumours of the urinary system and male genital organs. IARC Press, LyonGoogle Scholar
  6. 6.
    Humphrey PA et al (2016) The 2016 WHO classification of tumours of the urinary system and male genital organs-part B: prostate and bladder tumours. Eur Urol 70(1):106–119CrossRefGoogle Scholar
  7. 7.
    Oliva E, Young RH (1996) Clear cell adenocarcinoma of the urethra: a clinicopathologic analysis of 19 cases. Modern Pathol 9(5):513–520Google Scholar
  8. 8.
    Nakatsuka S et al (2012) A case of clear cell adenocarcinoma arising from the urethral diverticulum: utility of urinary cytology and immunohistochemistry. Cytojournal 9:11CrossRefGoogle Scholar
  9. 9.
    Scantling D, Ross C, Jaffe J (2013) Primary clear cell adenocarcinoma of a urethral diverticulum treated with multidisciplinary robotic anterior pelvic exenteration. Case Rep Med 2013:387591CrossRefGoogle Scholar
  10. 10.
    Sheahan G, Vega AV (2013) Primary clear cell adenocarcinoma in a female urethral diverticulum: a case report and review. World J Nephrol Urol 2:29–32Google Scholar
  11. 11.
    Venyo AK (2015) Clear cell adenocarcinoma of the urethra: review of the literature. Int J Surg Oncol 2015:790235PubMedPubMedCentralGoogle Scholar
  12. 12.
    National Cancer Institiue (2019) Overview of the SEER program 2019. Available at: Accessed 22 Feb 2019
  13. 13.
    Merrill RM et al (2000) Cancer prevalence estimates based on tumour registry data in the Surveillance, Epidemiology, and End Results (SEER) Program. Int J Epidemiol 29(2):197–207CrossRefGoogle Scholar
  14. 14.
    Swartz MA et al (2006) Incidence of primary urethral carcinoma in the United States. Urology 68(6):1164–1168CrossRefGoogle Scholar
  15. 15.
    Rane SR, GhodkeAN Vishwasrao S (2017) Clear cell adenocarcinoma of female urethra. J Clin Diagn Res. 11(7):ED01–ED02PubMedPubMedCentralGoogle Scholar
  16. 16.
    Gonzalez MO, Harrison ML, Boileau MA (1985) Carcinoma in diverticulum of female urethra. Urology 26(4):328–332CrossRefGoogle Scholar
  17. 17.
    Patanaphan V et al (1983) Adenocarcinoma arising in female urethral diverticulum. Urology 22(3):259–264CrossRefGoogle Scholar
  18. 18.
    Srinivas V, Dow D (1983) Transitional cell carcinoma in a urethral diverticulum with a calculus. J Urol 129(2):372–373CrossRefGoogle Scholar
  19. 19.
    Weng WC et al (2013) Clear cell carcinoma of female urethral diverticulum—a case report. J Formos Med Assoc 112(8):489–491CrossRefGoogle Scholar
  20. 20.
    Oliva E et al (2002) Clear cell carcinoma of the urinary bladder: a report and comparison of four tumors of mullerian origin and nine of probable urothelial origin with discussion of histogenesis and diagnostic problems. Am J Surg Pathol 26(2):190–197CrossRefGoogle Scholar
  21. 21.
    Lah K et al (2013) Primary vesical clear cell adenocarcinoma arising in endometriosis: a rare case of mullerian origin. Anticancer Res 33(2):615–617PubMedGoogle Scholar
  22. 22.
    Adeniran AJ, Tamboli P (2009) Clear cell adenocarcinoma of the urinary bladder: a short review. Arch Pathol Lab Med 133(6):987–991PubMedGoogle Scholar
  23. 23.
    Yamashita R et al (2006) Urothelial carcinoma (clear cell variant) diagnosed with useful immunohistochemistry stain. Int J Urol 13(11):1448–1450CrossRefGoogle Scholar
  24. 24.
    Klimis T, Dellaportas GP (2012) Clear cell variant of urothelial carcinoma. Hell J Surg 84(3):191–194CrossRefGoogle Scholar
  25. 25.
    Shalev M et al (2002) Squamous cell carcinoma in a female urethral diverticulum. Urology 59(5):773CrossRefGoogle Scholar
  26. 26.
    Gogus C et al (2003) Clear cell adenocarcinoma of the male urethra. Int J Urol 10(6):348–349CrossRefGoogle Scholar
  27. 27.
    Liu SV et al (2012) Metastatic clear cell adenocarcinoma of the urethra in a male patient: report of a case. Clin Genitourin Cancer 10(1):47–49CrossRefGoogle Scholar
  28. 28.
    Lewis S et al (2015) High-dose-rate brachytherapy—a novel treatment approach for primary clear cell adenocarcinoma of male urethra. J Contemp Brachytherapy 7(3):248–251CrossRefGoogle Scholar
  29. 29.
    Ebisuno S, Miyai M, Nagareda T (1995) Clear cell adenocarcinoma of the female urethra showing positive staining with antibodies to prostate-specific antigen and prostatic acid phosphatase. Urology 45(4):682–685CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity of Arkansas for Medical SciencesLittle RockUSA

Personalised recommendations