The experience of diagnosis and treatment as well as the prognosis analysis of urachal cancer / 中华泌尿外科杂志

ABSTRACT

Objectives:To summarize the experience of treatment of 23 cases of urachal carcinoma in order to improve the diagnosis and treatment of urachal carcinoma.Methods:Clinical data of a total of 23 patients with urachal carcinoma from January 2014 to August 2019, including 19 males and 4 females, with a median age of 53 years (34 to 84 years) were retrospectively analyzed. The most common symptom was painless gross hematuria (20/23, 87.0%). All patients underwent CT examination before operation. Three of them had calcification (13.0%), and the median maximum diameter was 3.5 cm (2.0-7.0 cm). Preoperative cystoscopy revealed 23 cases of anterior or parietal mass of the bladder. Partial cystectomy and urachectomy were performed in 17 cases, partial cystectomy plus urachectomy (including umbilectomy) were performed in 5 cases, and total cystectomy were performed in 1 case. Eleven patients (47.8%) underwent pelvic lymph node dissection. Twenty-one cases (91.3%) had Sheldon stage Ⅲ or above tumors.Results:There were 21 cases of urachal adenocarcinoma and 2 cases of transitional cell carcinoma with adenoid differentiation. Five patients underwent adjuvant therapy (21.7%), including 1 patient of 5-fluorouracil (5-fu)+ cisplatin, two patients of gemcitabine+ cisplatin, and one patient of gemcitabine+ cisplatin+ vascular endothelial inhibitor. One case underwent local pelvic radiotherapy alone. No recurrence or metastasis occurred during the follow-up period. All patients were followed up for 38 months (2 to 68 months). A total of 3 patients developed distant metastasis and died during follow-up. The death occurred at 15 months, 40 months, and 49 months after surgery, all of which were caused by tumor metastasis. Two other patients had recurrence at 9 and 13 months after surgery, respectively, and they were followed up for 55 and 25 months after recurrence. Survival analysis showed that the 2-year cancer-specific survival rate was 94.1%, and the 5-year cancer-specific survival rate was 74.9%.Conclusions:Early diagnosis of urachal cancer is difficult. Emphasizing the examination of the urachus during physical examination may help early detection. Surgery-based comprehensive treatment can achieve good tumor control for localized umbilical carcinoma. The accurate pathological staging through pelvic lymph node dissection and the early postoperative adjuvant therapy may improve the prognosis of the patients.