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

Area of Science:

• Oncology
• Urologic Oncology
• Cancer Staging

Background:

• Urachal carcinoma (UrC) is a rare and aggressive malignancy.
• Diagnosis often occurs at advanced stages, complicating treatment.
• Existing staging systems (Sheldon, Mayo, Ontario) lack validation due to small patient cohorts.

Purpose of the Study:

• To develop and validate a novel staging system for UrC.
• To compare the proposed system against established staging methods.
• To improve risk stratification and clinical decision-making for UrC patients.

Main Methods:

• Utilized a large patient cohort from the National Cancer Database (2004-2016).
• Developed a novel staging system based on the Tumor (T), Node (N), and Metastasis (M) (TNM) framework.
• Compared the TNM system with Sheldon, Mayo, and Ontario systems using Kaplan-Meier curves and Cox regression for overall survival (OS).

Main Results:

• Analysis included 626 UrC patients; median OS was 58.2 months.
• The novel TNM system showed a more balanced sample and survival distribution per stage compared to existing systems.
• TNM, Mayo, and Ontario systems demonstrated better stage-survival correlation than the Sheldon system.

Conclusions:

• The proposed TNM staging system for UrC provides a more balanced distribution and accurate stage-survival correlation.
• This clinically applicable system enhances risk stratification, prognosis, and therapeutic decision-making.
• The TNM system offers a superior framework for managing urachal carcinoma.