Signet ring cell urachal carcinoma (SRUC) is a rare and aggressive variant of urachal carcinoma with limited large-scale epidemiological data. This study analyzes the demographic distribution, clinicopathologic features, treatment patterns, and survival outcomes of SRUC patients using data from the National Cancer Database (NCDB).

A retrospective study was conducted using NCDB data on patients diagnosed with SRUC. Demographic variables, tumor staging, treatment modalities, and survival outcomes were analyzed. Kaplan-Meier survival analysis was performed, and survival estimates were reported with 95% confidence intervals (CI).

A total of 60 patients with signet ring cell urachal carcinoma were analyzed. The majority were male (65%) and White (76.7%). Most cases were managed at academic/research (33.3%), reflecting the complexity of SRUC requiring specialized care. The majority of patients (73.3%) had a comorbidity score of 0, indicating no significant pre-existing medical conditions.

Clinically, cT3 (18.4%) and cT2 (16.7%) tumors were the most common, suggesting that many tumors were diagnosed at locally advanced stages. Distant metastases (cM1) were present in 13.3% of cases at diagnosis. Pathologically, pT3 tumors (36.9%) were the most frequent, indicating perivesical tissue invasion. Lymph node status was unknown in 53.4% (pNX) of cases. Among those assessed, pN0 (36.7%) was the most frequent, suggesting that many cases did not have lymph node involvement. However, pN1 (6.7%) and pN2 (3.3%) cases indicated the presence of regional nodal metastases, highlighting a subset of patients with more aggressive disease.

Regarding treatment, partial cystectomy (56.7%) was the predominant surgical approach, whereas only 8.3% underwent radical cystectomy, likely due to the anatomical location of urachal tumors, permitting more conservative surgery. Chemotherapy was administered in 36.7% of cases, with multi-agent therapy (31.7%) being the most common regimen. The median overall survival was 29.6 months for signet ring cell carcinoma compared to urachal adenocarcinoma which was 78.9 months (p<0.001), indicating that a significant proportion of SRUC patients had poor outcomes.

SRUC is an aggressive malignancy with poor median survival despite surgical and systemic treatment.

This NCDB-based analysis highlights the need for standardized treatment approaches and further research into targeted therapies to improve patient outcomes.