Survival benefit of chemotherapy in a contemporary cohort of metastatic urachal carcinoma

Rocco Simone Flammia; Francesco Chierigo; Christoph Würnschimmel; Benedikt Horlemann; Benedikt Hoeh; Gabriele Sorce; Zhen Tian; Costantino Leonardo; Derya Tilki; Carlo Terrone; Fred Saad; Shahrokh F Shariat; Francesco Montorsi; Felix Kh Chun; Michele Gallucci; Pierre I Karakiewicz

doi:10.1016/j.urolonc.2021.09.008

Survival benefit of chemotherapy in a contemporary cohort of metastatic urachal carcinoma

Urol Oncol. 2022 Apr;40(4):165.e9-165.e15. doi: 10.1016/j.urolonc.2021.09.008. Epub 2021 Oct 20.

Authors

Rocco Simone Flammia¹, Francesco Chierigo², Christoph Würnschimmel³, Benedikt Horlemann⁴, Benedikt Hoeh⁵, Gabriele Sorce⁶, Zhen Tian⁴, Costantino Leonardo⁷, Derya Tilki⁸, Carlo Terrone⁴, Fred Saad⁴, Shahrokh F Shariat⁹, Francesco Montorsi¹⁰, Felix Kh Chun¹¹, Michele Gallucci⁷, Pierre I Karakiewicz⁴

Affiliations

¹ Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. Electronic address: roccosimone92@gmail.com.
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁵ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
⁶ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁷ Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy.
⁸ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁹ Departments of Urology, Weill Cornell Medical College, New York, New York, USA; Department of Urology, University of Texas Southwestern, Dallas, Texas, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁰ Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹¹ Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.

PMID: 34686429
DOI: 10.1016/j.urolonc.2021.09.008

Abstract

Background: We relied on the most contemporary Surveillance, Epidemiology, and End Results (SEER) database and tested the hypothesis that chemotherapy may improve survival in metastatic urachal carcinoma (m-UraC).

Material and methods: Within the SEER database (2004-2016), we identified m-UraC patients aged ≥ 18 years. Propensity score matching (PSM: cystectomy status, age and sex), Kaplan-Meier plots, cumulative incidence plots, Cox regression models and competing risks regression (CRR) models addressed overall mortality (OM) and cancer-specific mortality (CSM).

Results: Overall, 274 m-UraC patients were identified with a median age of 70 years. Most were male (66%) and Caucasian (72%). Overall, 32% received chemotherapy. Chemotherapy-exposed patients were younger (62 vs. 73 years, p<0.001) and more frequently underwent cystectomy (19 vs. 8%, P = 0.014). In 274 m-UraC patients, median OM and CSM were 6 (4 -10) months and 8 (6 -14) months, respectively. After 1:1 PSM, chemotherapy-exposed patients exhibited lower OM (median 16 vs. 3 months; multivariable HR 0.38, P <0.001) and lower CSM (median 17 vs. 4 months; multivariable CRR HR 0.52, P = 0.001). The association between chemotherapy and better survival was even stronger in younger (≤70 years) patients (OM HR: 0.23, P <0.001; CSM CRR HR: 0.42, P = 0.001), but not in older (≥71 years) patients (OM HR: 0.61, P = 0.2; CSM CRR HR: 1.02, P = 1), after PSM and multivariable adjustments.

Conclusion: Overall, we validated the very aggressive nature of UraC, when distant metastases are present, and observed that m-UraC patients exposed to chemotherapy exhibited lower OM and CSM.

Keywords: Adenocarcinoma; Chemotherapy; Malignant neoplasms; Metastatic disease; SEER; Urachal cancer; Urachus; Urinary Bladder Neoplasms.

MeSH terms

Aged
Carcinoma, Transitional Cell* / pathology
Cystectomy
Female
Humans
Male
SEER Program
Urinary Bladder Neoplasms* / pathology

Supplementary concepts

Urachal cancer