Abstract
AimThis study evaluated the prognosis and survival predictors for bladder urachal carcinoma (UC), based on large scale multicenter cohort with long term follow-up database.MethodsA total 203 patients with bladder UC treated at 19 hospitals were enrolled. Clinical parameters on carcinoma presentation, diagnosis, and therapeutic methods were reviewed for the primary cancer and for all subsequent recurrences. The stage of UC was stratified by Mayo and Sheldon pathological staging system. Oncological outcomes and the possible clinicopathological parameters associated with survival outcomes were investigated.ResultsThe mean age of the patients was 54.2 years. Among the total of 203 patients, stages I, II, III, and IV (Mayo stage) were 48 (23.8%), 108 (53.5%), 23 (11.4%), and 23 (11.4%), respectively. Gross hematuria and bladder irritation symptoms were the two most common initial symptoms. The mean follow-up period was 65 months, and 5-year overall survival rates (OS), cancer-specific survival rates (CSS), and recurrence-free survival rates (RFS) were 88.3, 83.1, and 63.9%, respectively. For the patients with Mayo stage ≥III, OS, CSS, and RFS were significantly decreased to 38.0, 35.2, and 28.4%, respectively. The higher pathological stage (Mayo stage ≥III, Sheldon stage ≥IIIc), positive surgical margin (PSM), and positive lymphovascular invasion (PLM) were independent predictors of shorter OS, CSS, and RFS.ConclusionThe pathological stage, PSM, and PLM were significantly associated with the survival of UC patients, emphasizing an importance of the complete surgical resection of tumor lesion.
Highlights
During the fetal development, the urachus obliterates and subsequently forms the median umbilical ligament, a 5–10 cm long fibromuscular canal, which extraperitoneally connects between umbilicus and the roof of bladder in the midline
Urachal carcinoma (UC) is relatively rare urologic malignancy, which most frequently occurs within the urachal remnant located at the junction between umbilical ligament and dome of the urinary bladder, whereas it can be even found in any location along the midline of the bladder [4]
Many previous studies have reported that UC cases treated with surgical resection had a median survival of 48 months, and no definite difference in survival rates were observed according to different surgical modalities including partial and radical cystectomy [9]
Summary
The urachus obliterates and subsequently forms the median umbilical ligament, a 5–10 cm long fibromuscular canal, which extraperitoneally connects between umbilicus and the roof of bladder in the midline. Regarding the incidence of disease entity, recent retrospective study based on the National Cancer Registry in Ireland presented that UC accounts for 0.3% of overall bladder cancer incidence [5]. Many previous studies have reported that UC cases treated with surgical resection had a median survival of 48 months, and no definite difference in survival rates were observed according to different surgical modalities including partial and radical cystectomy [9]. Due to the low prevalence of UC, previous literatures regarding clinical characteristics of UC had a relatively small case series with retrospective nature. The present study is a retrospective multi-center based research, which primarily investigated the clinical characteristics and oncological outcomes of UC patients treated at overall 19 large scale medical institutions in South Korea. We tried to clarify the clinical and therapeutic factors influencing the oncological outcomes of UC cases
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