scholarly journals The clinicopathological features and prognostic value of lymphovascular invasion in patients with upper tract urinary carcinoma after radical nephroureterectomy:  an updated systematic review and meta-analysis.

2019 ◽  
Author(s):  
Lijin Zhang ◽  
Bin Wu ◽  
Zhenlei Zha ◽  
Hu Zhao ◽  
Jun Yuan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factor ◽  
Prognostic Value ◽  
Lymphovascular Invasion ◽  
Meta Analysis ◽  
Clinicopathological Features ◽  
Current Evidence ◽  
Radical Nephroureterectomy ◽  
Poor Prognostic Factor ◽  
Upper Tract

Abstract Background and Purpose: Although the prognostic value of lymphovascular invasion (LVI) for upper tract urinary carcinoma (UTUC) have been described. There is lack of consensus regarding the prognostic factor of LVI in UTUC. The aim of present study was to evaluate the current evidence regarding the contemporary role of LVI through systematic review and meta-analysis according to the updated literatures. Materials and Methods: In the light of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search of Web of Science, PubMed and EMBASE was performed for all reports published until July 2019 that included detailed results on the predictors of LVI. Results: Our meta-analysis included thirty one eligible studies containing 14,653 UTUC patients (81-1,363 per study). According to our final results, there was a significant correlation of LVI with worse cancer-specific survival (CSS) (HR=1.62, 95 % CI: 1.49-1.76, p < 0.001), overall survival (OS) (HR=1.55, 95 % CI: 1.41-1.71, p < 0.001), recurrence-free survival (RFS) (HR=1.46, 95 % CI: 1.32-1.61, p < 0.001), cancer-specific mortality (CSM) (HR=1.25, 95 % CI: 1.00-1.56, p = 0.047) and recurrence(HR=1.23, 95 % CI: 1.03-1.48, p = 0.026). In addition, LVI was also correlated with advanced TNM stage (III/IV vs. I/II: OR = 7.63, 95% CI: 5.60–10.39, p < 0.001), higher tumor grade (3 vs. 1/2: OR = 5.61, 95% CI: 3.71–8.48, p < 0.001), lymph node metastasis (yes vs. no: OR = 4.95, 95% CI: 3.66–6.71, p < 0.001), carcinoma in situ (yes vs. no: OR = 1.92, 95% CI: 1.36–2.70, p < 0.001) and positive surgical margin (yes vs. no: OR = 4.38, 95% CI: 2.71–7.07, p < 0.001), but not related to gender (male vs. female: OR = 0.98, 95% CI: 0.80–1.19, p = 0.825) and multifocality (multifocal vs. unifocal: OR = 1.10, 95% CI: 0.82–1.47, p = 0.539). The funnel plot test indicated that no significant publication bias in the meta-analysis. Conclusions: This study demonstrated that LVI was associated with more aggressive clinicopathological features and could serve as a poor prognostic factor for patient with UTUC after radical nephroureterectomy.

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.

Prognostic Value of Variant Histology in Upper Tract Urothelial Carcinoma Treated with Nephroureterectomy: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 203 (6) ◽  
pp. 1075-1084 ◽  
Author(s):  
Keiichiro Mori ◽  
Florian Janisch ◽  
Mehdi Kardoust Parizi ◽  
Hadi Mostafaei ◽  
Ivan Lysenko ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urothelial Carcinoma ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Variant Histology
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