Postoperative progression-free survival and clinicopathological risk stratification in urachal carcinoma: A multicenter retrospective cohort study

AIM: To evaluate postoperative progression-free survival (PFS), identify clinicopathological factors associated with PFS, and explore the association between postoperative adjuvant therapy and PFS after surgery for urachal carcinoma. METHODS: We retrospectively included 72 patients with histopathologically confirmed malignant urachal tumors treated at 2 medical centers between January 2009 and December 2025. PFS was estimated using the Kaplan-Meier method, and associated factors were evaluated using prespecified Cox regression models. RESULTS: The cohort included 65 adenocarcinomas and 7 urothelial carcinomas. All patients had Sheldon stage III (n = 65) or IV (n = 7) disease, and 28 received postoperative adjuvant therapy. The median follow-up was 48 months (95% confidence interval [CI], 30-75), during which 26 patients experienced disease progression or death. The 1-, 3-, and 5-year PFS rates were 85.7% (95% CI, 77.9%-94.3%), 66.2% (95% CI, 54.9%-79.9%), and 55.7% (95% CI, 43.2%-71.8%), respectively. In the primary multivariable model, Sheldon stage IV disease was associated with shorter PFS (HR, 4.32; 95% CI, 1.23-15.14; P = 0.022). No statistically significant association between postoperative adjuvant therapy and PFS was observed after multivariable adjustment (HR, 1.14; 95% CI, 0.50-2.58; P = 0.754). CONCLUSIONS: Among patients with Sheldon stage III-IV disease, the 5-year postoperative PFS rate was 55.7%. Sheldon stage IV disease was associated with shorter PFS. No statistically significant association between postoperative adjuvant therapy and PFS was observed after multivariable adjustment; however, this finding should be interpreted cautiously.