Prognostic Factors for Patients With Urachal Carcinoma Undergoing Radical Surgery: Risk Stratification for Future Prospects of Precision Oncology

Purpose: To determine poor prognostic factors for patients with urachal carcinoma (UrC) undergoing radical surgery; identify candidates for precision oncology, including adjuvant therapy; and improve survival outcome of this rare malignant disease. Materials and Methods: We included 51 patients with UrC who underwent radical or partial cystectomy at our institution between 1991 and 2023. Kaplan-Meier curves and log-rank test were performed to estimate overall survival (OS) and recurrence-free survival by applying the Ontario staging system. A Cox proportional hazard regression model was used for multivariate analysis to evaluate prognostic factors for patients undergoing radical surgery. Results: Univariate and multivariate analyses showed that tumor involvement of perivesical fat (Ontario stage T3) and tumor grade were significant prognostic factors for OS. Tumor involvement of perivesical fat was a common factor for both OS and recurrence-free survival. Patients with both adverse factors showed significantly poor OS compared with those with 1 or no adverse factors ( P = .014 and .0014, respectively). Conclusions: Tumor involvement of perivesical fat and tumor grade were strong predictors of survival outcome. Adjuvant therapy might be indicated in patients with high recurrence risk. Our results warrant further, multidisciplinary investigation into the impact of precision oncology for patients with UrC and high recurrence risk.