Anterior wall adenocarcinoma of bladder with similar clinicopathological and prognostic characteristics as common bladder carcinomas should not be treated as or classified into urachal adenocarcinomas

Abstract

Purpose To discuss whether the dome or anterior wall of bladder adenocarcinoma (BAC) should be classified into urachal carcinoma (UrC) and the relationship of primary tumor location (PTL) as well as treatment with survival. Methods Surveillance, Epidemiology, and End Results 18 database was examined for eligible patients from 1975 to 2016. Patients were classified into adenocarcinoma originating from the urachus (UAC), the dome (D‐BAC), the anterior wall (A‐BAC), and the other sites adenocarcinoma of the bladder (O‐BAC). The clinicopathological features, treatment, and survival were compared among the groups. Results Comparable clinicopathologic features were obtained between UAC and D‐BAC, which were different from those of A‐BAC and O‐BAC; otherwise, the latter two had similar clinicopathologic features. Univariable and multivariable Cox regression analyses indicated that PTL was an independent predictor for survival. O‐BAC conferred the worst prognosis then followed by A‐BAC, D‐BAC, and UAC. For non‐metastatic UAC or D‐BAC, partial cystectomy (with an en bloc resection of the urachus and umbilicus) is optimal for survival. However, the worse survival of non‐metastatic D‐BAC (compared with UAC) suggested different modalities, maybe more intensive surgery approaches, should be considered for D‐BAC. Conclusion This study illustrates that PTL of UAC and BAC was an independent predictor for survival. A‐BAC had comparable characters and prognosis with O‐BAC and should not be classified into and treated as UrC. For non‐metastatic disease, non‐metastatic D‐BAC may need more intensive modality.

Urachus adenocarcinoma mistaken for umbilical incision implant cancer after laparoscopic cholecystectomy: a case report

“…The location of the growth site is connected to the clinical manifestations of urachal carcinoma: 90% of tumors located at the distal end of the urachus can press on the bladder and break through the bladder after hematuria; 6% of tumors located in the middle of the urachus or invading the abdominal wall can reach the mass in the lower abdomen; 4% of tumors located near the urachal tube ruptured early and the umbilical cord flowed out with mucous or bloody fluid [11]. The onset of urachus cancer is insidious, and due to its deep location next to the Retzius space there are generally no clinical manifestations in the early stages; thus, most of these tumors invade the bladder, and present with gross hematuria as their initial symptom [12]. Ultrasound is the most common clinical examination method, and acoustic images of urachus cancer mainly show an uneven hypoechoic mass with calcification, often protruding into the bladder cavity.…”

Urachal Carcinoma, An Unusual Possibility of Hematuria; Case Report and Literature Review

“…While early diagnosis is mandatory for patients with UrC, no clear risk factors were identified. Multiple parameters were evaluated, such as age, sex, tumor grade, tumor size, LN status, Sheldon stage, Mayo stage, the presence of distant metastasis, surgical intervention, positive surgical margin and anatomopathological type of the tumor [ 16 , 27 , 28 ]. The meta-analysis conducted by Szarvas et al uncovered that criteria, such as Sheldon stage 4IIIB, Mayo stage 4II, presence of LN or distant metastases, positive surgical margin, and ECOG performance status, were independent risk predictors [ 12 ].…”

Web-Based Prediction Models for Overall Survival and Cancer-Specific Survival of Patients With Primary Urachal Carcinoma: A Study Based on SEER Database

“…As a rare malignant tumor of the genitourinary system, UrC is characterized by atypical clinical symptoms, bleak prognoses, and rapid disease progression ( 3 , 5 ). Although UrC is included as a category of bladder malignancy, previous studies have shown that the two should not be confused in clinical management ( 21 ). Due to the lack of typical clinical symptoms of the disease, the difficulty in identifying the disease even with cystoscopy, and the lack of a clear consensus on the choice of comprehensive treatment, the disease is often advanced at the time of presentation, leading to a poor prognosis ( 22 – 24 ).…”