Signet ring cell carcinoma of the urachus: survival and pathologic outcomes from the national cancer database

Signet ring cell carcinoma (SRCC) of the urachus is a rare and aggressive histologic variant with limited guidance on optimal treatment. This study aimed to characterize the clinicopathological features, treatment patterns, and survival outcomes of urachal SRCC using a large national dataset and to assess the impact of surgical and systemic therapies on prognosis.

We queried the National Cancer Database (NCDB) for patients diagnosed with urachal SRCC between 2004 and 2020. Clinical and pathological staging, surgical approach (partial vs. radical cystectomy), chemotherapy use, and overall survival were analyzed. Kaplan-Meier survival curves and statistical comparisons were used to evaluate treatment outcomes.

A total of 60 patients with SRCC of the urachus were identified. A substantial proportion presented with advanced or unstaged disease (43.3% cTX, 38.4% pTX). Partial cystectomy was performed more often than radical cystectomy (56.7% vs. 31.6%). Chemotherapy was administered in 38.4% of patients, most commonly as multi-agent regimens. Median overall survival was approximately 30 months. No significant survival benefit was observed with chemotherapy administration.

Urachal SRCC is associated with poor survival and considerable heterogeneity in staging and management. Our findings suggest limited observed benefit of systemic therapy in this cohort, underscoring the need for further prospective studies.