Dados do Trabalho

Título

Systematic Review of Urachal Adenocarcinoma: Clinical Characteristics, Treatment Outcomes and Prognostic Factors

Resumo

Introduction: Urachal adenocarcinoma is a rare and aggressive malignancy, representing a small percentage of bladder cancers. Due to its rarity, a variety of management approaches are based on case series and isolated reports. This study systematically reviews the available literature on urachal adenocarcinoma, focusing on epidemiology, clinical presentation, diagnostic methods, treatment options and outcomes.

Objective: To summarize the current literature knowledge on urachal adenocarcinoma.

Method: We conducted a systematic review of published studies on urachal adenocarcinoma. The search was conducted in March 2024 on PubMed using the terms "urachal carcinoma" "urachal adenocarcinoma" and "urachal cancer" and covered the period from January 1946 to March 2024. In this review, we included patients diagnosed with urachal adenocarcinoma and studies involving at least 10 patients. Exclusion criteria were primary bladder tumors that were not urachal adenocarcinomas, adenocarcinomas in other organs, data from government databases, case reports, case series with less than 10 patients or incomplete information, editorial letters, expert opinions, literature reviews and patients under 18 years old.

Results: In total, data from 2082 patients were analyzed, including 1318 males (63,3%) and 764 females (36,7%). The median age ranging was from 51,5 to 58 years. The most common symptom was hematuria (37,7%). The principal histological variant was mucinous adenocarcinoma (24,8%). For diagnosis, computed tomography was used in 19%, magnetic resonance imaging in 3% and positron emission tomography in 1%. Surgical treatments included partial cystectomy in 58,5% of cases and radical cystectomy in 7,8%. Umbilectomy was performed in 13,8% and lymphadenectomy in 9,5%. Neoadjuvant chemotherapy was administered in 10%. Adjuvant chemotherapy included 5-Fluorouracil (10%), Gemcitabine (3%) and Cisplatin (15%). The median follow-up duration was 36 months. Recurrence was reported in 20%. Predictors of survival included tumor stage, surgical margin and lymphovascular invasion.

Conclusion: Urachal adenocarcinoma is a rare malignancy with specific clinical and pathological characteristics. Early detection and complete surgical ressection with negative margins are crucial for improving outcomes. Adjuvant therapy may be considered in advanced cases. Further research is needed to standardize treatment protocols and optimize therapeutic strategies for this challenging disease.

Palavras Chave

urachal adenocarcinoma; systematic review