요막관암의 임상적 특성 및 예후

Abstract

Purpose: We evaluated the clinical characteristics of the patients with urachal cancer, and we also analyzed their prognosis. Materials and Methods: Medical records for 14 patients who were diagnosed with urachal cancer during the last fifteen years were retrospectively analyzed in regards to their clinical characteristics. Survival probabilities of 26 patients, 14 of whom were at our institute and 12 of whom were previously reported in the Korean Journal of Urology, were estimated using Kaplan-Meier curves. Results: The incidence of urachal cancer was 1.2% of all primary bladder malignancies seen at our institute. The most common presenting symptom was gross hematuria (71.4%), and other symptoms included suprapubic pain or mass (28.6%), frequency or residual urine sensation (14.3%) and mucusuria (7.1%). We performed surgical resection on 12 patients, partial cystectomy on 8 patients, total cystectomy on 3 patients and pelvic exenteration on 1 patient. Histologic examination revealed 13 mucinous adenocarcinomas and 1 adenosquamous cell carcinomas. The surgical margins were free of tumor in 10 (83.3%) patients. 9 patients were classified as stage IIIA and 1, 2, 1, and 1 patients were classified as stage IIIB, IIIC, IIID and IVB, respectively. The overall survival rates (n=26) were 71.1% at 2 years and 45.1% at 5 years. The survival probabilities in the partial cystectomy group (n=16) were 100.0% and 61.4% at 2 and 5 years respectively, and 60.0% and 40.0% at 2 and 5 years, respectively, in the total cystectomy group (n=6). There was no significant difference between the two groups (p>0.05). Conclusions: Urachal cancer is rare, and its incidence was 0.4% of all primary bladder malignancies reported in Korea. Generally, the prognosis is unfavorable because early diagnosis is difficult and local invasions, distant metastasis and recurrences frequently develop. However, we would expect a more favorable prognosis if proper surgical resection following the correct preoperative diagnosis is performed. In addition, partial cystectomy would be a good treatment if negative surgical margins were ensured.