TNM-Based Head-to-Head Comparison of Urachal Carcinoma and Urothelial Bladder Cancer: Stage-Matched Analysis of a Large Multicenter National Cohort

• Published in: Cancer research and treatment Vol. 55; no. 4; pp. 1337 - 1345
• Main Authors: Song, Sang Hun, Lee, Jaewon, Ko, Young Hwii, Kim, Jong Wook, Jung, Seung Il, Kang, Seok Ho, Park, Jinsung, Seo, Ho Kyung, Kim, Hyung Joon, Jeong, Byong Chang, Kim, Tae-Hwan, Choi, Se Young, Nam, Jong Kil, Ku, Ja Yoon, Joo, Kwan Joong, Jang, Won Sik, Yoon, Young Eun, Yun, Seok Joong, Hong, Sung-Hoo, Oh, Jong Jin
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Cancer Association 01.10.2023; 대한암학회
• Subjects: Original; 의학일반; Survival analysis; Cystectomy; Urinary bladder neoplasms; Neoplasm staging; TNM classification; Urachal cancer
• ISSN: 1598-2998; 2005-9256; 2005-9256
• DOI: 10.4143/crt.2023.417

Purpose Outcome analysis of urachal cancer (UraC) is limited due to the scarcity of cases and different staging methods compared to urothelial bladder cancer (UroBC). We attempted to assess survival outcomes of UraC and compare to UroBC after stage-matched analyses.Materials and Methods Total 203 UraC patients from a multicenter database and 373 UroBC patients in single institution from 2000 to 2018 were enrolled (median follow-up, 32 months). Sheldon stage conversion to corresponding TNM staging for UraC was conducted for head-to-head comparison to UroBC. Perioperative clinical variables and pathological results were recorded. Stage-matched analyses for survival by stage were conducted.Results UraC patients were younger (mean age, 54 vs. 67 years; p < 0.001), with 163 patients (80.3%) receiving partial cystectomy and 23 patients (11.3%) radical cystectomy. UraC was more likely to harbor ≥ pT3a tumors (78.8% vs. 41.8%). While 5-year recurrence-free survival, cancer-specific survival (CSS) and overall survival were comparable between two groups (63.4%, 67%, and 62.1% in UraC and 61.5%, 75.9%, and 67.8% in UroBC, respectively), generally favorable prognosis for UraC in lower stages (pT1-2) but unfavorable outcomes in higher stages (pT4) compared to UroBC was observed, although only 5-year CSS in ≥ pT4 showed statistical significance (p=0.028). Body mass index (hazard ratio [HR], 0.929), diabetes mellitus (HR, 1.921), pathologic T category (HR, 3.846), and lymphovascular invasion (HR, 1.993) were predictors of CSS for all patients.Conclusion Despite differing histology, UraC has comparable prognosis to UroBC with relatively favorable outcome in low stages but worse prognosis in higher stages. The presented system may be useful for future grading and risk stratification of UraC.