Prognostic Factors for Urachal Cancer: A Bayesian Model-Averaging Approach

PURPOSE: This study was conducted to evaluate prognostic factors and cancer-specific survival (CSS) in a cohort of 41 patients with urachal carcinoma by use of a Bayesian model-averaging approach. MATERIALS AND METHODS: Our cohort included 41 patients with urachal carcinoma who underwent extended partial cystectomy, total cystectomy, transurethral resection, chemotherapy, or radiotherapy at a single institute. All patients were classified by both the Sheldon and the Mayo staging systems according to histopathologic reports and preoperative radiologic findings. Kaplan-Meier survival curves and Cox proportional-hazards regression models were carried out to investigate prognostic factors, and a Bayesian model-averaging approach was performed to confirm the significance of each variable by using posterior probabilities. RESULTS: The mean age of the patients was 49.88+/-13.80 years and the male-to-female ratio was 24:17. The median follow-up was 5.42 years (interquartile range, 2.8-8.4 years). Five- and 10-year CSS rates were 55.9% and 43.4%, respectively. Lower Sheldon (p=0.004) and Mayo (p<0.001) stage, mucinous adenocarcinoma (p=0.005), and larger tumor size (p=0.023) were significant predictors of high survival probability on the basis of a log-rank test. By use of the Bayesian model-averaging approach, higher Mayo stage and larger tumor size were significant predictors of cancer-specific mortality in urachal carcinoma. CONCLUSIONS: The Mayo staging system might be more effective than the Sheldon staging system. In addition, the multivariate analyses suggested that tumor size may be a prognostic factor for urachal carcinoma.

Prognostic Factors for Urachal Cancer: A Bayesian Model-Averaging Approach

PURPOSE: This study was conducted to evaluate prognostic factors and cancer-specific survival (CSS) in a cohort of 41 patients with urachal carcinoma by use of a Bayesian model-averaging approach. MATERIALS AND METHODS: Our cohort included 41 patients with urachal carcinoma who underwent extended partial cystectomy, total cystectomy, transurethral resection, chemotherapy, or radiotherapy at a single institute. All patients were classified by both the Sheldon and the Mayo staging systems according to histopathologic reports and preoperative radiologic findings. Kaplan-Meier survival curves and Cox proportional-hazards regression models were carried out to investigate prognostic factors, and a Bayesian model-averaging approach was performed to confirm the significance of each variable by using posterior probabilities. RESULTS: The mean age of the patients was 49.88+/-13.80 years and the male-to-female ratio was 24:17. The median follow-up was 5.42 years (interquartile range, 2.8-8.4 years). Five- and 10-year CSS rates were 55.9% and 43.4%, respectively. Lower Sheldon (p=0.004) and Mayo (p<0.001) stage, mucinous adenocarcinoma (p=0.005), and larger tumor size (p=0.023) were significant predictors of high survival probability on the basis of a log-rank test. By use of the Bayesian model-averaging approach, higher Mayo stage and larger tumor size were significant predictors of cancer-specific mortality in urachal carcinoma. CONCLUSIONS: The Mayo staging system might be more effective than the Sheldon staging system. In addition, the multivariate analyses suggested that tumor size may be a prognostic factor for urachal carcinoma.

Urachal Cancer in a 47-Year-Old Patient: A Case Report and Literature Review.

Aims: Urachal cancer is an uncommon neoplasm associated with poor prognosis. No concensus has been reached regarding diagnostic criteria so far. The management of urachal carcinoma is controversial, too. In this case presentation, we reported a 47 year old female with urachal cancer and treatment approach discussed with published literature. Presentation of Case: A 47-year-old female patient was admitted with abdominal pain and hematuria. A soft mass was noticed under her navel. Computerized tomography revealed a tumor which is a cystic lesion arising from the urachus and a solid mass component at the urinary bladder dome. The tumor was removed by partial cycectomy. Histological examination showed urachal adenocarcinoma (colonic type and well differentiated), which had invaded the urinary bladder. The patient has been followed up without a recurrence for the next 6 months. Discussion: Urachal carcinoma is a rare type of, approximately 0.5 to 2%, bladder neoplasms. The pathogenesis of urachal tumours is not fully understood, so far. Currently, the most effective treatment of localized urachal cancer is cystectomy. It is unclear whether lymphadenectomy or chemotherapy is usefull for the patients with urachal carcinoma. Conclusion: Regarding the treatment of urachal cancer, surgery remains the mainstay of therapy. Moreover, the achievement of a complete urachectomy, including umbilectomy and negative surgical margins, is critical for low-stage, localized, welldifferentiated urachal cancer.

Immediate Umbilical Reconstruction after Removal of Umbilicus due to Urachal Cancer: Defatting, Anchoring and Purse-String Suture

Reconstruction of the umbilicus is not a frequent event. Umbilical restoring should always be aimed at creating an umbilicus of sufficient depth and good morphology(circular and cylinder shape) with less scarring. A wide range of techniques has been described to reconstruct neoumbilicus; nevertheless, a perfect result is difficult to obtain. I provide another alternative to reconstruct the umbilicus using defatting, anchoring and purse-string suture. The important steps are the following; the first step is defatting of 2.0cm umbilicus' circle. The second step is to umbilical fixation to the fascia wall using anchoring suture. The third step is purse-string suture to decrease new formative umbilicus and to make the circular and cylinder shape umbilicus. The author's method is a simple, easy and useful technique and renders better aesthetic result. So, I reviewed two cases and discussed the literatures.

Immediate Umbilical Reconstruction for Urachal Cancer

The umbilicus is a central line of abdomen and can be an important aesthetic interest in the abdomen wall, so its loss can be a source of psychological distress. Many techniques for reconstruction of a lost umbilicus have been described, however none has achieved a perfect result. There are few reports that describe the procedure for immediate reconstruction of umbilicus after surgical ablation except Miller's Iris technique. We have performed umbilical reconstruction right after the umbilicus was resected during the surgery. The patient was a 34 year old man with urachal cancer, who wanted to have his lost umbilicus reconstructed immediately for personal, social, and aesthetic reasons. We tried immediate reconstruction with modified iris technique. Using three local flaps, we fixed the central portion of inferior flap at the area of 1 cm below umbilical defect on linea alba. The neoumbilicus retained in its depth and natural shape. This technique is considered to be simple and draw good results.