In terms of immunotherapy, although immune checkpoint inhibitors (ICIs) have demonstrated promise across various urologic malignancies, urachal NEC typically exhibits low PD-L1 expression, low tumor mutational burden (TMB), and microsatellite stability (MSS)—characteristics of an immunologically “cold” tumor, which may limit responsiveness to ICIs (83–85, 88). This evidence concerns the gene CD274 and neoplasm.