Surgical treatment of recurrent urachal carcinoma with liver metastasis: a case report and literature review

Urachal carcinoma: A novel staging system utilizing the National Cancer Database

BACKGROUND

Urachal carcinoma (UrC) is a rare, aggressive cancer with a poor prognosis that is frequently diagnosed in advanced stages. Due to its rarity, the current staging systems, namely Sheldon, Mayo, and Ontario were established based on relatively small patient cohorts, necessitating further validation. We used a large patient population from the National Cancer Database to model a novel staging system based on the Tumor (T), Node(N), and Metastasis (M) (TNM) staging system and compared it to established staging systems.

METHODS

We identified patients diagnosed with UrC between the years of 2004-2016. To determine median overall survival (OS), a Kaplan-Meier (KM) curve was generated using the Sheldon, Mayo, Ontario, and TNM staging system. A cox proportional-hazards regression model was developed to highlight predictors of overall survival.

RESULTS

A total of 626 patients were included in the analysis. The OS for the entire cohort was 58.2 months (50.1-67.8) with survival rates at 12, 24, and 60 months of 83%, 70%, and 49%, respectively (p < 0.0001). As compared to the Sheldon, Mayo, and Ontario staging system, our TNM staging system had a more balanced sample and survival distribution per stage and no overlap among stages on KM survival curves. The Mayo, Ontario, and TNM staging systems were more accurate in terms of stage-survival correlation than the Sheldon staging system (p < 0.05 for all stages).

CONCLUSIONS

The proposed novel TNM staging system for UrC has a more balanced sample distribution and a more accurate stage-survival correlation than the traditional Mayo, Sheldon, and Ontario staging systems. It is clinically applicable and enables better risk stratification, prognosis, and therapeutic decision-making.

Malignant transformation of a urachal cyst-a case report and literature review

Urachal remnant diseases are very uncommon pathologies which are mostly benign. Rarely they can progress to a very aggressive form of Urachal cancer. The rarity of this condition has precluded large studies to help guide the diagnostic and therapeutic management of these potentially malignant lesions. In this case, a urachal cyst was discovered and conservative management was employed after a biopsy proved the lesion was benign. Unfortunately this patient represented several years later with a locally advanced urachal cancer. To date, this is the first clearly documented case of malignant transformation. The available literature surrounding these urachal cysts and cancers will be reviewed to determine if anything could have been done differently in this case and in the future should a similar case present.