Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta-analysis

2017 ◽  
Vol 121 (2) ◽  
pp. 184-193 ◽  
Author(s):  
Run-Qi Guo ◽  
Peng Hong ◽  
Geng-Yan Xiong ◽  
Lei Zhang ◽  
Dong Fang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Radical Nephroureterectomy ◽  
Upper Tract ◽  
Oncological Outcomes ◽  
Urothelial Carcinomas

scholarly journals The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Łukasz Nowak ◽  
Wojciech Krajewski ◽  
Joanna Chorbińska ◽  
Paweł Kiełb ◽  
Michał Sut ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Cochrane Library ◽  
Radical Nephroureterectomy ◽  
Free Survival ◽  
Upper Tract ◽  
Oncological Outcomes ◽  
The Impact

Background: The incidence of intravesical recurrence (IVR) following radical nephroureterectomy (RNU) is reported in up to 50% of patients with upper tract urothelial carcinoma (UTUC). It was suggested that preoperative diagnostic ureteroscopy (URS) could increase the IVR rate after RNU, however, the available data are often conflicting. Thus, in this systematic review and meta-analysis we sought to synthesize that available data for the impact of pre-RNU URS for UTUC on IVR and other oncological outcomes; Materials and methods: A systematic literature search of the PubMed, Embase and Cochrane Library databases was performed in June 2020. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CI) were conducted. The primary endpoint was intravesical recurrence-free survival (IVRFS), with the secondary endpoints being cancer-specific survival (CSS), overall survival (OS), and metastasis-free survival (MFS); Results: Among a total of 5489 patients included in the sixteen selected papers, 2387 (43.4%) underwent diagnostic URS before RNU and 3102 (56.6%) did not. Pre-RNU diagnostic URS was significantly associated with worse IVRFS after RNU (HR=1.44, 95% CI: 1.29-1.61, p<0.001) than RNU alone. However, subgroup analysis including patients without biopsy during URS revealed no significant impact of diagnostic URS on IVRFS (HR=1.28, 95% CI: 0.90-1.80, p=0.16). The results of other analyses showed no significant differences in CSS (HR=0.94, p=0.63), OS (HR: 0.94, p=0.56), and MFS (HR: 0.91, p=0.37) between patients who underwent URS before RNU and those who did not. Conclusions: The results of this meta-analysis confirm that diagnostic URS prior to RNU is significantly associated with worse IVRFS, albeit with no concurrent impact on the other long-term survival outcomes. Our results indicate that URS has a negative impact on IVRFS only when combined with endoscopic biopsy. Future studies are warranted to assess the role of immediate postoperative intravesical chemotherapy in patients undergoing biopsy during URS for suspected UTUC.

scholarly journals The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (18) ◽  
pp. 4197
Author(s):  
Łukasz Nowak ◽  
Wojciech Krajewski ◽  
Joanna Chorbińska ◽  
Paweł Kiełb ◽  
Michał Sut ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Cochrane Library ◽  
Radical Nephroureterectomy ◽  
Free Survival ◽  
Upper Tract ◽  
Oncological Outcomes ◽  
The Impact

Background: The incidence of intravesical recurrence (IVR) following radical nephroureterectomy (RNU) is reported in up to 50% of patients with upper tract urothelial carcinoma (UTUC). It was suggested that preoperative diagnostic ureteroscopy (URS) could increase the IVR rate after RNU. However, the available data are often conflicting. Thus, in this systematic review and meta-analysis we sought to synthesize available data for the impact of pre-RNU URS for UTUC on IVR and other oncological outcomes. Materials and methods: A systematic literature search of the PubMed, Embase, and Cochrane Library databases was performed in June 2021. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CI) were conducted. The primary endpoint was intravesical recurrence-free survival (IVRFS), with the secondary endpoints being cancer-specific survival (CSS), overall survival (OS), and metastasis-free survival (MFS). Results: Among a total of 5489 patients included in the sixteen selected papers, 2387 (43.4%) underwent diagnostic URS before RNU and 3102 (56.6%) did not. Pre-RNU diagnostic URS was significantly associated with worse IVRFS after RNU (HR = 1.44, 95% CI: 1.29–1.61, p < 0.001) than RNU alone. However, subgroup analysis including patients without biopsy during URS revealed no significant impact of diagnostic URS on IVRFS (HR = 1.28, 95% CI: 0.90–1.80, p = 0.16). The results of other analyses showed no significant differences in CSS (HR = 0.94, p = 0.63), OS (HR: 0.94, p = 0.56), and MFS (HR: 0.91, p = 0.37) between patients who underwent URS before RNU and those who did not. Conclusions: The results of this meta-analysis confirm that diagnostic URS prior to RNU is significantly associated with worse IVRFS, albeit with no concurrent impact on the other long-term survival outcomes. Our results indicate that URS has a negative impact on IVRFS only when combined with endoscopic biopsy. Future studies are warranted to assess the role of immediate postoperative intravesical chemotherapy in patients undergoing biopsy during URS for suspected UTUC.

scholarly journals Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Radosław Piszczek ◽  
Łukasz Nowak ◽  
Wojciech Krajewski ◽  
Joanna Chorbińska ◽  
Sławomir Poletajew ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Upper Tract Urothelial Carcinoma ◽  
Current Evidence ◽  
Recurrence Free Survival ◽  
Radical Nephroureterectomy ◽  
Free Survival ◽  
Upper Tract ◽  
Oncological Outcomes

Abstract Background During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU. Materials and methods The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled. Results Eighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60–1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62–1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85–1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94–1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter. Conclusions Our present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions.

scholarly journals Prognostic Value of Preoperative Hydronephrosis in Patients Undergoing Radical Nephroureterectomy for Upper Tract Urinary Carcinoma: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 10 ◽  
Author(s):  
Tao Ye ◽  
Xiaoqi Yang ◽  
Peng Lv ◽  
Haoran Liu ◽  
Zhangqun Ye
Keyword(s):  
Prognostic Value ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Current Evidence ◽  
Cochrane Library ◽  
Radical Nephroureterectomy ◽  
Eligibility Criteria ◽  
Free Survival ◽  
Upper Tract ◽  
Worse Prognosis

BackgroundSeveral recent publications have evaluated the prognostic value of preoperative hydronephrosis (HN) in patients with upper tract urinary carcinoma (UTUC). The aim of this meta-analysis was to explore the pooled effect of preoperative HN on the prognosis of UTUC patients treated with radical nephroureterectomy (RNU) based on current evidence.MethodsWe performed a systematic search of Pubmed, Cochrane library, and Web of Science databases from inception to June 2020. The outcomes of interest included overall survival (OS), cancer-special survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS).ResultsTwenty-two studies with a total of 7,542 patients satisfied the eligibility criteria and were finally included in this meta-analysis. The percent of patients with preoperative HN varied in the eligible studies, ranging from 18 to 81%. The pooled results showed that preoperative HN was significantly associated with worse OS (P = 0.004), CSS (P &lt; 0.001), and DFS (P = 0.005), but not IVRFS (P = 0.12). No obvious publication bias was detected by Begg’s test in all the analyses.ConclusionsThe results drawn in our meta-analysis suggest that the presence of preoperative HN is associated with worse prognosis in patients treated with RNU for UTUC. Therefore, closer surveillance and more aggressive therapy may be needed for UTUC patients present with preoperative HN. Well-designed prospective studies are necessary to substantiate the prognostic value of HN in UTUC.

scholarly journals Survival Benefits Based on the Number of Lymph Nodes Removed during Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (6) ◽  
pp. 1933 ◽  
Author(s):  
Min Soo Choo ◽  
Sangjun Yoo ◽  
Hyeong Dong Yuk ◽  
Chang Wook Jeong ◽  
Min Chul Cho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Lymph Node ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Case Control Studies ◽  
Level Of Evidence ◽  
Upper Tract

The role of lymph node dissection (LND) is still controversial for upper tract urothelial carcinoma (UTUC), and there are no guidelines regarding its use. This study was conducted to find a higher level of evidence for the survival benefits based on the number of LNs removed during radical nephroureterectomy (RNUx) through a systematic review and meta-analysis. We included studies comparing patients who underwent LND during RNUx for UTUC. We searched the major electronic databases (Pubmed, Embase®, and Scopus®) and conducted manual searches of the electronically available abstracts of the major international urology cancer meetings [American Society of Clinical Oncology (ASCO), American Urological Association (AUA), and Eropean Association of Urology (EAU)] prior to April 2019 using grouped terms of nephroureterectomy (nephroureterectom*) and lymph node excision (lymphadenectomy; lymph + node*; lymph* + metasta*) with variations in the terms. Study selection, data collection, and risk of bias assessment were performed by two independent authors (A and B). Six retrospective case-control studies included a total of 33,944 patients who underwent RNUx for UTUC, 5071 of whom underwent LND and were finally included in the meta-analysis. The pooled hazard ratio (HR) in these studies revealed that an increased number of LNs removed during RNUx was associated with improved cancer-specific survival (CSS) in patients with UTUC (HR = 0.95, 95% CI: 0.91–0.99; p = 0.07). In addition, increased numbers of LNs removed were associated with improved overall survival (OS) in pN0 patients. However, in pN+ patients, the number of LNs removed showed no survival benefit on CSS, overall survival (OS), or progression-free survival (PFS). Higher numbers of LNs removed during RNUx were associated with improved survival outcomes in patients with UTUC. This study confirmed that LND also has oncological benefits in UTUC patients. Although still a controversial topic, meticulous LND must be considered, and efforts should be made to eliminate as many LNs as possible when administering RNUx for UTUC, especially in patients without clear evidence of LN metastasis.

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