Urachal Carcinoma: Impact of Recurrence Pattern and Lymphadenectomy on Long-term Outcomes

Background: Urachal carcinoma is a rare nonurothelial malignant tumor with high rates of local recurrence and systemic metastasis. Although radical resection is widely considered the standard treatment, there is still a debate regarding the benefits of lymphadenectomy. To explore these factors, we investigated the recurrence pattern of urachal cancer and the impact of lymphadenectomy on long-term survival.

Methods: The data of 62 patients pathologically diagnosed with urachal carcinoma at Sun Yat-sen University Cancer Center from 2002 to 2019 were retrospectively reviewed. Lymphadenectomy was defined as lymph nodes retrieved from the obturator, internal iliac, and external iliac lymph node stations. The Kaplan-Meier method and Cox regression model were used to identify prognostic factors. OS and DFS were the primary endpoints.

Results: Of the 47 males and 15 females included, 54 patients underwent partial cystectomy, and 27 patients underwent lymphadenectomy. The number of patients with Sheldon stage IIIA, IIIB, IIIC, IVA, and IVB were 43 (69.4%), 4 (6.5%) 3 (4.8%), 6 (9.7%), and 6 (9.7%), respectively. The median DFS was 32.7 months, and the mean OS was 114.6 months. Sheldon stage (P < .001) and tumor size (P = .001) were identified as independent prognostic factors for DFS, whereas Sheldon stage (P = .003), peritoneal metastasis (P = .006), distant metastasis (P = .024), and recurrence in pelvic lymph nodes (P = .015) were independent prognostic factors for OS.

Conclusions: Urachal carcinoma has a high recurrence rate, but only peritoneal metastasis, distant metastasis, and recurrence in pelvic lymph nodes were found to be associated with OS. Lymphadenectomy was recommended because of its role in accurately staging the disease, and further research is needed to focus on lymphadenectomy and standardized the procedure.