Revisiting an Old Conundrum: A Systematic Review and Meta-Analysis of Intravesical Therapy for Treatment of Urothelial Carcinoma of the Prostate

BACKGROUND: The optimal management of non-invasive (mucosal and/or ductal) urothelial carcinoma of the prostate remains elusive and there is a paucity of data to guide treatment. OBJECTIVE: Our objective was to systematically review and synthesize treatment responses to conservative management of non-invasive prostatic urothelial carcinoma using intravesical therapy. METHODS: A systematic literature search using MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science databases from inception to November 2019 was performed. Risk of bias assessment was performed using the Newcastle-Ottawa scale for non-randomised studies. Pooled estimates of complete response in the bladder and prostate and prostate only were performed using a random effects model. Pre-specified subgroup analyses were generated to assess differences in complete responses for: BCG therapy vs other agents, ductal vs mucosal involvement, CIS vs papillary tumors and TURP vs no TURP. RESULTS: Nine studies including 175 patients were identified for inclusion in the systematic review and meta-analysis. All were retrospective case series and most evaluated response to BCG therapy. The pooled global complete response rate for intravesical therapy was 60%(95%CI: 0.48, 0.72), and for prostate 88%(95%CI: 0.81, 0.96). Pre-specified analyses did not demonstrate statistically significant differences between subgroups of interest. CONCLUSIONS: Management of non-invasive prostatic urothelial carcinoma using intravesical therapy yields satisfactory results. Caution should be taken in treating patients with papillary tumors and ductal involvement, as data for these populations is limited. TURP may not improve efficacy, but is required for staging. Current recommendations are based on low quality evidence, and further research is warranted.

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Predictive and Prognostic Role of PD-L1 in Urothelial Carcinoma Patients with Anti-PD-1/PD-L1 Therapy: A Systematic Review and Meta-Analysis

Disease Markers ◽

10.1155/2020/8375348 ◽

2020 ◽

Vol 2020 ◽

pp. 1-16

Author(s):

Haoran Liu ◽

Tao Ye ◽

Xiaoqi Yang ◽

Peng Lv ◽

Xiaoliang Wu ◽

...

Keyword(s):

Systematic Review ◽

Urothelial Carcinoma ◽

Web Of Science ◽

Meta Analysis ◽

Cochrane Library ◽

Platinum Based Chemotherapy ◽

Predictive And Prognostic Biomarker ◽

The Cochrane Library ◽

Predictive And Prognostic Value

Recently, checkpoint inhibition of the PD-1/PD-L1 axis has been shown to be therapeutically relevant in urothelial carcinoma (UC). To evaluate the predictive and prognostic value of PD-L1 on response and survival in UC patients after cystectomy, chemotherapy, or anti-PD-1/PD-L1 therapy, a systematic review of PubMed, Embase, Web of Science, and the Cochrane Library was performed. A total of 2154 patients from 14 published studies were included. In all UC patients after cystectomy, tumour cell (TC) PD-L1 expression was not associated with the OS or PFS. For the subset of patients with organ-confined disease, TC PD-L1 expression significantly predicted OS after cystectomy (P=0.0004). There was no significant evidence of an association between TC PD-L1 status and ORR or OS for UC patients treated with platinum-based chemotherapy. For UC patients treated with anti-PD-1/PD-L1 therapy, TC PD-L1 expression≥5% could predict the response (P=0.005), but not for the 1% cut-off (P≥0.05). As for PD-L1 expression in tumour-inflating immune cells (TIICs), both subsets with IC2/3 vs. IC0/1 and IC1/2/3 vs. IC0 were associated with ORR to anti-PD-1/PD-L1 therapy. In the TIIC subset, IC2/3 vs. IC0/1 of PD-L1 was associated with higher CR (P=0.002), PR (P=0.04), and PD (P=0.007). Further, higher TIIC PD-L1 status benefited from longer PFS (P<0.001), but was not associated with OS in UC patients with anti-PD-1/PD-L1 therapy. Our study suggested that TIIC PD-L1 expression with 5% cut-off was valuable as a predictive and prognostic biomarker for ORR and PFS in UC patients with anti-PD-1/PD-L1 therapy.

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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

10.20944/preprints202107.0387.v1 ◽

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&lt;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.

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Efficacy of High-Intensity Focused Ultrasound Combined With GnRH-a for Adenomyosis: A Systematic Review and Meta-Analysis

Frontiers in Public Health ◽

10.3389/fpubh.2021.688264 ◽

2021 ◽

Vol 9 ◽

Author(s):

Li-Li Pang ◽

Jin Mei ◽

Ling-Xiu Fan ◽

Ting-Ting Zhao ◽

Ruo-Nan Li ◽

...

Keyword(s):

Systematic Review ◽

Recurrence Rate ◽

High Intensity ◽

Focused Ultrasound ◽

Meta Analysis ◽

High Intensity Focused Ultrasound ◽

Cochrane Library ◽

Lesion Volume ◽

Non Invasive ◽

Serum Ca125

Objective: High-intensity focused ultrasound (HIFU) is an innovative non-invasive technology used for adenomyosis. Gonadotropin-releasing hormone agonist (GnRH-a) is a hormone commonly used for adenomyosis. We investigated and assessed the efficacy of HIFU combined with GnRH-a for adenomyosis.Methods: For this systematic review and meta-analysis, we searched Pubmed, Cochrane Library, Web of Science, Embase, CNKI, WanFang, and VIP databases for relevant articles published in Chinese or English that compared HIFU combined with GnRH-a vs. HIFU alone in patients with adenomyosis. The last literature search was completed on January 31, 2021. Two reviewers independently assessed study eligibility and assessed risk of bias. Another two reviewers extracted the data. The RevMan5.3 software was used for the data analysis. Changes in volume of the uterine and adenomyotic lesion were defined as the primary outcomes. The secondary outcomes were visual analog scale (VAS) scores for dysmenorrhea, menstrual volume scores, serum CA125 levels, and recurrence rate. This study is registered with PROSPERO (CRD42021234301).Results: Three hundred and ninety potentially relevant articles were screened. Nine studies with data for 766 patients were finally included. Compared with the HIFU alone group, the HIFU combined with GnRH-a group had a higher rate of uterine volume reduction (MD 7.51, 95% CI 5.84–9.17, p < 0.00001), smaller adenomyotic lesion volume (MD 4.11, 95% CI 2.93–5.30, p < 0.00001), lower VAS score for dysmenorrhea (MD 1.27, 95% CI 0.54–2.01, p = 0.0007) and menstrual volume score (MD 0.88, 95% CI 0.73–1.04, p < 0.00001), and lower CA125 level (SMD 0.31, 95% CI 0.05–0.56, p = 0.02) after the procedure. The recurrence rate in the HIFU combined with GnRH-a group was lower than that in the HIFU alone group (RR 0.28, 95% CI 0.10–0.82, p = 0.02).Conclusions: Compared with HIFU treatment alone, HIFU combined with GnRH-a for the treatment of adenomyosis has greater efficacy in decreasing the volumes of the uterine and adenomyotic lesions and alleviating symptoms. However, since the number of the included studies was too small and most of them were written in Chinese, this conclusion needs to be referenced with caution. And the long-term evidence of its efficacy is still insufficient.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ identifier [CRD42021234].

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Effects of Non-Invasive Neurostimulation on Autism Spectrum Disorder: A Protocol for a Systematic Review

10.21203/rs.3.rs-1103851/v1 ◽

2021 ◽

Author(s):

Jiawei Zhang ◽

Hao Zhang

Keyword(s):

Systematic Review ◽

Autism Spectrum Disorder ◽

Meta Analysis ◽

Neurodevelopmental Disorder ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Cochrane Library ◽

Clinical Effects ◽

Non Invasive ◽

Invasive Neurostimulation

Abstract Background Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder marked by characteristic impairments in social communication and interaction, as well as restricted and repetitive behavior. There is a continued need for exploring effective interventions and evaluating treatment options for ASD. Transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are non-invasive neurostimulation techniques which have shown clinical benefits in adult psychiatric conditions. While in ASD patients, no guideline has so-far recommended on the application of NIBS due to a lack of high-quality synthetic evidence. Therefore, objective of this study will be to systematically evaluate the evidence on clinical effects of non-invasive neurostimulation in patients with ASD. Methods We designed and registered a study protocol for a systematic review. A comprehensive search from database inception onwards will be conducted in PubMed, EMBASE and Cochrane library. Randomized and non-randomized sham-controlled studies assessing the effects of noninvasive neurostimulation in patients with ASD will be identified. Eligibility of citations retrieved will be independently screened by two reviewers. The risk of bias and quality of included studies will be appraised using appropriate tools. A narrative synthesis around the features of the evidences will provided. There may be a chance for meta-analysis to pool the estimates of studies included if three studies or more meet the requirements for meta-analysis. If so, a random-effects model maybe applied. And we will evaluate heterogeneity between studies using the I² statistic. Discussion This systematic review will provide a broad and comprehensive evaluation of the evidence on clinical effects of TMS and tDCS in patients with ASD. Our findings will be reported according to the PRISMA guidelines and may add more confidence when healthcare professionals are making informed decisions about the choice of this therapy. Results will be published in a peer-reviewed journal. Systematic review registration: Submitted to PROSPERO, 20/11/2021

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The prognostic role of tumor-infiltrating lymphocytes in urothelial carcinoma of bladder: A systematic review and meta-analysis

10.21203/rs.2.22616/v1 ◽

2020 ◽

Author(s):

Zhiqiang Yang ◽

Yujin Bai ◽

Xu Hu ◽

Ping Han

Keyword(s):

Systematic Review ◽

Urothelial Carcinoma ◽

Prognostic Value ◽

Meta Analysis ◽

Tumor Infiltrating Lymphocytes ◽

Cochrane Library ◽

Prognostic Impact ◽

Infiltrating Lymphocytes ◽

Urothelial Carcinoma Of Bladder

Abstract Background: Tumor-infiltrating lymphocytes (TILs) in the tumor microenvironment are associated with different prognosis in various malignancies. However, their prognostic impact remains controversial in urothelial carcinoma of bladder (UCB). In this systematic review and meta-analysis, we aimed to investigate the prognostic value of TILs in UCB patients.Methods: A systematic review and meta-analysis was performed using Pubmed, Embase and Cochrane Library. Studies were eligible if they investigated the prognostic value of CD3+, CD4+, CD8+, Foxp3+ lymphocytes or TILs in UCB patients, by time-to-event survival analysis. All studies were appraised for risk of bias using the Quality and Prognosis Studies (QUIPS) criteria. Hazard rations (HRs) with their 95% confidence interval (CIs) from each study were used to generate pooled HRs. Results: A total of 14 studies assessing the impact of TILs on prognostic outcomes in UCB patients were included in final analysis. The pooled analysis indicated a favorable role of CD3+ TILs (HR 0.74 (95% CI 0.62-0.88) for overall survival) and CD8+ TILs (HR 0.46 (95% CI 0.28-0.74) for OS) in the clinical outcomes of UCB, while Foxp3+ TILs were associated with worse survival (HR 2.21 (95% CI 1.47-3.32) for recurrence-free survival). Conclusions: This systematic review and meta-analysis confirmed the favorable prognostic impact of CD3+ and CD8+ tumor-infiltrating T cells in UCB patients and found the association between Foxp3+ TILs and worse survival. Future studies using large cohorts and standardized methodology with regard to tumor subsites, stages and treatment modalities are needed to incorporate TILs with clinical practice.

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Prognostic value of preoperative hematologic biomarkers in urothelial carcinoma of the bladder treated with radical cystectomy: a systematic review and meta-analysis

International Journal of Clinical Oncology ◽

10.1007/s10147-020-01690-1 ◽

2020 ◽

Vol 25 (8) ◽

pp. 1459-1474 ◽

Cited By ~ 2

Author(s):

Keiichiro Mori ◽

Noriyoshi Miura ◽

Hadi Mostafaei ◽

Fahad Quhal ◽

Reza Sari Motlagh ◽

...

Keyword(s):

Systematic Review ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Prognostic Value ◽

Meta Analysis ◽

Primary Data ◽

Cochrane Library ◽

Cancer Specific Survival ◽

Neutrophil Lymphocyte Ratio ◽

Carcinoma Of The Bladder

Abstract This systematic review and meta-analysis aimed to assess the prognostic value of preoperative hematologic biomarkers in patients with urothelial carcinoma of the bladder treated with radical cystectomy. PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in September 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared cancer-specific survival in patients with urothelial carcinoma of the bladder with and without pretreatment laboratoryabnormalities. Formal meta-analyses were performed for this outcome. The systematic review identified 36 studies with 23,632 patients, of these, 32 studies with 22,224 patients were eligible for the meta-analysis. Several preoperative hematologic biomarkers were significantly associated with cancer-specific survival as follows: neutrophil − lymphocyte ratio (pooled hazard ratio [HR]: 1.20, 95% confidence interval [CI]: 1.11–1.29), hemoglobin (pooled HR: 0.87, 95% CI 0.82–0.94), C-reactive protein (pooled HR: 1.44, 95% CI 1.26–1.66), De Ritis ratio (pooled HR: 2.18, 95% CI 1.37–3.48), white blood cell count (pooled HR: 1.05, 95% CI 1.02–1.07), and albumin-globulin ratio (pooled HR: 0.26, 95% CI 0.14–0.48). Several pretreatment laboratory abnormalities in patients with urothelial carcinoma of the bladder were associated with cancer-specific mortality. Therefore, it might be useful to incorporate such hematologic biomarkers into prognostic tools for urothelial carcinoma of the bladder. However, given the study limitations including heterogeneity and retrospective nature of the primary data, the conclusions should be interpreted with caution.

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Sarcomatoid variant urothelial carcinoma of the bladder: a systematic review and meta-analysis of the clinicopathological features and survival outcomes

Cancer Cell International ◽

10.1186/s12935-020-01626-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Liangyou Gu ◽

Qing Ai ◽

Qiang Cheng ◽

Xin Ma ◽

Baojun Wang ◽

...

Keyword(s):

Systematic Review ◽

Urothelial Carcinoma ◽

Meta Analysis ◽

Progression Free Survival ◽

Clinicopathological Features ◽

Cochrane Library ◽

Survival Outcomes ◽

Cancer Specific Survival ◽

Comprehensive Search ◽

Carcinoma Of The Bladder

Abstract Background A systematic review and meta-analysis was performed to compare the clinicopathological features and survival outcomes between sarcomatoid variant (SV)-urothelial carcinoma of the bladder (UCB) and conventional UCB (C-UCB). Methods A comprehensive search of PubMed, Embase, and Cochrane Library was performed. Endpoints included clinicopathological features and survival outcomes (overall survival [OS], cancer-specific survival [CSS], and progression-free survival [PFS]). The survival benefits of neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC) for SV-UCB also have been studied. Results A total of 8 observational studies were included. Patients with SV-UCB had a higher rate of ≥ stage pT3 (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.64–2.59; p < 0.001) and a lower rate of concomitant carcinoma in situ (OR, 0.25; 95% CI, 0.09–0.72; p = 0.010). The other clinicopathological variables were similar between SV-UCB and C-UCB. With unadjusted data, patients with SV-UCB had a significant inferior OS (HR, 1.24; 95% CI, 1.07–1.44; p = 0.004) and CSS (HR, 2.08; 95% CI, 1.63–2.66; p < 0.001). However, after adjusted, SV-UCB had worse OS (HR, 1.41; 95% CI, 0.95–2.08; p = 0.090) and CSS (HR, 1.54; 95% CI, 0.95–2.52; p = 0.080) approaching the borderline of significance. For SV-UCB, NAC (HR, 0.73; 95% CI, 0.51–1.05; p = 0.090) and AC (HR, 0.88; 95% CI, 0.66–1.17; p = 0.370) seemed to have no benefit on OS. Conclusions Compared to C-UCB, SV-UCB was associated with more advanced disease and more inferior OS and CSS. NAC and AC had no survival benefit for SV-UCB.

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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

Journal of Clinical Medicine ◽

10.3390/jcm10184197 ◽

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.

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Infiltration and Sealing for Managing Non-Cavitated Proximal Lesions: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-55900/v1 ◽

2020 ◽

Author(s):

Yuanyuan Chen ◽

Dongru Chen ◽

Huancai Lin

Keyword(s):

Systematic Review ◽

High Risk ◽

Meta Analysis ◽

Low Risk ◽

Cochrane Library ◽

Caries Risk ◽

Moderate Risk ◽

Risk Levels ◽

Non Invasive ◽

Caries Lesions

Abstract Background: Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels.Methods: Electronic databases (Cochrane Library, PubMed and Embase) were searched for published literature, and references were manually searched. Split-mouth randomized controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. In total, 995 citations were identified, and 16 RCTs (21 articles) were included.Results: For subgroup analysis, infiltration and sealing reduced the odds of lesion progression (infiltration vs non-invasive: OR = 0.20, 95% CI: 0.15 to 0.29; sealing vs placebo: OR = 0.27, 95% CI: 0.18 to 0.41). For both primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI: 0.20 to 0.45; permanent dentition: OR = 0.19, 95% CI: 0.13 to 0.27). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.19, 95% CI: 0.14 to 0.27). For patients with different risk levels, there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.23, 95% CI: 0.07 to 0.75; low to moderate risk: OR=0.38, 95% CI: 0.18 to 0.81; moderate to high risk: OR=0.17, 95% CI: 0.17 to 0.29; and high risk: OR=0.14, 95% CI: 0.07 to 0.26). Infiltration was superior to non-invasive treatments for patients at different caries risk levels (low risk: OR = 0.07, 95% CI: 0.02 to 0.22; low to moderate risk: OR=0.38, 95% CI: 0.18 to 0.81; moderate to high risk: OR=0.19, 95% CI: 0.09 to 0.38; and high risk: OR=0.14, 95% CI: 0.07 to 0.29).Conclusion: Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.

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The Prognostic Value of Body Mass Index in Patients With Urothelial Carcinoma After Surgery: A Systematic Review and Meta-Analysis

Dose-Response ◽

10.1177/1559325820979247 ◽

2020 ◽

Vol 18 (4) ◽

pp. 155932582097924

Author(s):

Zhiqiang Yang ◽

Yunjin Bai ◽

Xu Hu ◽

Xiaoming Wang ◽

Ping Han

Keyword(s):

Systematic Review ◽

Body Mass Index ◽

Urothelial Carcinoma ◽

Body Mass ◽

Prognostic Value ◽

Protective Factor ◽

Meta Analysis ◽

Oncologic Outcomes ◽

Cochrane Library ◽

Cancer Specific Survival

Background: The clinical evidence of body mass index (BMI) for survival has increased in urothelial carcinoma (UC). This study aimed to investigate the prognostic value of BMI on the oncologic outcomes of patients with UC after surgery. Methods: The systematic review and meta-analysis was performed using Pubmed, Embase and Cochrane Library. We collected hazard ratio (HR) and 95% confidence interval (CI) on cancer specific survival (CSS), overall survival (OS) and recurrence-free survival (RFS) from the studies including upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of bladder (UCB). Results: A total of 13 studies comprising over 12,200 patients were enrolled in the quantitative synthesis. Compared with normal weight, overweight was associated with better CSS (HR = 0.87, 95% CI: 0.79-0.95) and RFS (HR = 0.86, 95% CI: 0.78-0.96). Meanwhile, we found that obese patients had worse CSS (HR = 1.14, 95%CI: 1.03-1.26), OS (HR = 1.31, 95% CI: 1.19-1.44) and RFS (HR = 1.24, 95% CI: 1.12-1.37). We observed that underweight was associated with inferior CSS (HR = 1.87, 95% CI: 1.54-2.26) in UTUC patients. Conclusions: Overweight was a protective factor for patients with UC after surgery, while obesity and underweight predicted unfavorable survival. Individual BMI may be considered for prognostication after surgeries and patient stratification for clinical trials.

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