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.