Analysis Of Clinical Features And Prognostic Factors Of Urachal Carcinoma

ObjectiveUrachal carcinoma is an extremely rare epithelial cancer of the urinary system of umbilical duct origin.It has the characteristics of insidious disease and easy metastasis.Urachal carcinoma are usually found at an advanced stage with a poor prognosis.At present,there is no standardized diagnosis and treatment standard.This study aims to analyze the clinical characteristics and prognosis of umbilical duct carcinoma,deepen the understanding and improve the level of diagnosis and treatment,and provide reference for the clinical diagnosis and treatment of patients with urachal carcinomaMethodsRetrospective analysis between August 2011 and November 2019,the first affiliated hospital of zhengzhou university were the clinical data of 35 cases of urachal carcinoma(contains general information,clinical symptoms,physical examination,imaging results(including color ultrasound,CT,MRI,PET/CT imaging,etc.),surgical methods,intraoperative conditions,postoperative pathology results,adjuvant chemotherapy regimen,and postoperative outcomes,etc)Regular follow-up was conducted through telephone follow-up,out-patient revisit,medical records inquiry and other methods.The end point was September 1,2020 or the date of death.After the follow-up,statistical analysis was performed on the collected clinical data to obtain the prognostic factors of patients with umbilical duct cancer.ResultsThere were 35 patients in this group,including 23 males and 12 females,with a male to female ratio of 1.92:1.The mean age was(52.1±13.9)years old and the median age was 55 years old.8 cases had a history of smoking and 3 cases had a history of alcohol use.There were 5 cases of hypertension,5 cases of diabetes mellitus,2 cases of coronary heart disease and 1 case of cerebral infarction.The initial symptoms were hematuria in 25 cases,abdominal pain in 4 cases,abdominal mass in 2 cases,umbilical pus in 1 case,and asymptomatic 4 cases.Preoperative CT examination showed that the tumors were located in the top wall of the bladder in 24 cases and in the anterior wall in 11 cases.The tumors were solid in 25 cases and cystic in 10 cases.The median tumor size was 4.0(1.5-11.0)cm.Preoperative cystoscopy found masses in the anterior or parietal wall of the bladder in all 35 cases.All 35 cases of umbilical duct carcinoma were diagnosed preoperatively.All 35 patients underwent extended partial cystectomy(conventional removal of umbilical cord),and 3 patients underwent pelvic lymph node dissection at the same time.Among them,19 cases underwent open surgery,14 cases underwent laparoscopic surgery,and 2 cases underwent Da Vinci robot-assisted laparoscopic surgery.This group of 35 cases of postoperative Mayo 10 cases of stage for Ⅰ,Ⅱ period 18 cases,Ⅲ period in 1 case,Ⅳ period 6 cases.The overall follow-up rate was 91.4%(32/35),and the median follow-up time was 41(3-103)months.The 1-,3-and 5-year survival rates were 82.5%,59.3%and 53.9%,respectively.Univariate analysis showed that age(P=0.033),maximum tumor size(P=0.011),lymph node metastasis(P=0.002),distant metastasis(P=0.011),pathological grade(P=0.001)and Mayo stage(P=0.026)were prognostic factors.Cox multivariate analysis showed that high pathological grade(HR=1.640,95%CI 1.1122.418,P=0.013)and tumor maximum diameter ≥ 4 cm(HR=5.000,95%CI 1.09922.755,P=0.037)were independent factors affecting the prognosis of UrC.ConclusionUrachal carcinoma is an extremely rare epithelial malignant tumor of the urinary system caused by umbilical duct.Urachal carcinoma is prone to metastasis,and when umbilical duct carcinoma does not develop metastasis,surgical treatment is the main treatment method.The Canadian Urological Association recommends extended partial cystectomy with complete resection of the umbilical duct and umbilical cord for localized UrC,and laparoscopic surgery is recommended as the first choice.Postoperative intravenous chemotherapy can be used as adjuvant,which can improve the prognosis of metastatic UrC to some extent.Pathological grade and tumor maximum diameter were independent factors affecting the prognosis of patients with umbilical duct carcinoma.The higher the pathological grade,the larger the tumor maximum diameter,and the shorter the survival time.Therefore,early screening and intervention are beneficial to increase the survival time and improve the survival expectation of patients.