MP56-16 SURGICAL MANAGEMENT OF CLINICALLY LOCALIZED URACHAL CARCINOMA: EVALUATING THE ROLE OF LYMPHADENECTOMY AS STANDARD OF CARE (2022)

You have accessJournal of UrologyCME1 May 2022MP56-16 SURGICAL MANAGEMENT OF CLINICALLY LOCALIZED URACHAL CARCINOMA: EVALUATING THE ROLE OF LYMPHADENECTOMY AS STANDARD OF CARE Kyle Rose, Erica Roberts, Heather Huelster, Andrew Chang, Logan Zemp, Alice Yu, Michael Poch, Roger Li, Phillippe Spiess, Scott Gilbert, and Wade Sexton Kyle RoseKyle Rose More articles by this author , Erica RobertsErica Roberts More articles by this author , Heather HuelsterHeather Huelster More articles by this author , Andrew ChangAndrew Chang More articles by this author , Logan ZempLogan Zemp More articles by this author , Alice YuAlice Yu More articles by this author , Michael PochMichael Poch More articles by this author , Roger LiRoger Li More articles by this author , Phillippe SpiessPhillippe Spiess More articles by this author , Scott GilbertScott Gilbert More articles by this author , and Wade SextonWade Sexton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002639.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Diverse practice patterns exist in the management of urachal carcinoma (UC). Case series involving this malignancy remain relatively small, precluding evidence-based revisions to clinical practice. Our aim was to utilize a large national dataset to better understand clinical and pathologic factors impacting oncologic outcomes and the role of lymphadenectomy. METHODS: The National Cancer Database (NCDB) was queried for patients with pure adenocarcinoma histology (8140, 8480, 8481, 8490) at expected UC locations (C67.1, C67.3, C67.7). Patients were excluded if there was metastatic disease (cN+M+), incomplete tumor staging or unavailable tumor size. The primary outcome was overall survival (OS) stratified by pathologic tumor and node characteristics. The secondary outcome was the presence of pathologically positive lymph node disease (pN+) based on primary tumor size. Survival data was estimated with Kaplan-Meier method, and evaluated using Log-rank test. RESULTS: After screening, 629 patients were identified in the NCDB with cN0M0 UC. Median patient age was 59.0 years, and median tumor size was 4.0 cm. Surgical margins were positive in 61 of 516 (12%) patients who had complete margin status documented. Lymphadenectomy was performed at the time of surgery in 326 (52%) patients, of whom 66 (20%) had pN+ disease. Death occurred in 329 (52%) patients, with a median OS of 73 months (95% CI 67.8-79.4). The results of the OS analysis are shown in Table 1. Tumor size >5cm contributed to a lower OS (63 vs. 77.2 months, p=0.05). The incidence of pN+ cancer increased with primary tumor size (Table 2). CONCLUSIONS: High rates of positive surgical margins and lymph node positive disease advocate for wide surgical excision and routine lymphadenectomy as standard of care in patients with UC. Despite excluding patients with cN+M+ UC, study limitations include the presence of surgeon selection bias for lymphadenectomy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e978 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Rose More articles by this author Erica Roberts More articles by this author Heather Huelster More articles by this author Andrew Chang More articles by this author Logan Zemp More articles by this author Alice Yu More articles by this author Michael Poch More articles by this author Roger Li More articles by this author Phillippe Spiess More articles by this author Scott Gilbert More articles by this author Wade Sexton More articles by this author Expand All Advertisement PDF DownloadLoading ...