Thomas Seisen1, Benjamin Granger2, Pierre Colin3, Priscilla Léon1, Guillemette Utard4, Raphaële Renard-Penna5, Eva Compérat6, Pierre Mozer7, Olivier Cussenot1, Shahrokh F Shariat8, Morgan Rouprêt9. 1. Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-URO, Institut Universitaire de Cancérologie, Paris, France. 2. Academic Department of Public Health and Biostatistics, Pitié-Salpétrière Hospital, Paris, France. 3. Department of Urology, Hôpital Privé de La Louvière, Générale de Santé, Lille, France. 4. Academic Library of Medicine, Paris Descartes University, Paris, France. 5. Academic Department of Radiology, Pitié-Salpétrière Hospital, Paris, France. 6. Academic Department of Pathology, Pitié-Salpétrière Hospital, Paris, France. 7. Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France. 8. Academic Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 9. Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-URO, Institut Universitaire de Cancérologie, Paris, France. Electronic address: morgan.roupret@psl.aphp.fr.
Abstract
CONTEXT: There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC). OBJECTIVE: To assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis. EVIDENCE ACQUISITION: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all reports that included detailed results of multivariate analyses on the predictors of IVR. According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, we selected 18 retrospective studies that each included more than 100 patients treated exclusively with RNU between 2007 and 2014. Cumulative analyses of available hazard ratios (HRs) and their corresponding 95% confidence intervals were conducted using R software to assess the potential predictors of IVR. EVIDENCE SYNTHESIS: Among the 8275 patients included, 2402 (29%) were diagnosed with IVR within a median time of 22.2 mo (range 6.7-56.5). Patient-specific predictors were as follows: male gender (HR 1.37; p<0.001), previous bladder cancer (HR 1.96; p<0.001), and preoperative chronic kidney disease (HR 1.87; p=0.002). Tumor-specific predictors were as follows: positive preoperative urinary cytology (HR 1.56; p<0.001), ureteral location (HR 1.27; p<0.001), multifocality (HR 1.61; p=0.002), invasive pT stage (HR 1.38; p<0.001), and necrosis (HR 2.17; p=0.02). Treatment-specific predictors were as follows: a laparoscopic approach (HR 1.62; p=0.003), extravesical bladder cuff removal (HR 1.22; p=0.02), and positive surgical margins (HR 1.90; p=0.004). CONCLUSIONS: A meta-analysis of available data identified significant predictors of IVR that should be systematically assessed to propose a risk-adapted approach to adjuvant intravesical instillation of chemotherapy and cystoscopic surveillance after RNU. PATIENT SUMMARY: In this report, we looked at the factors linked to intravesical recurrence after radical nephroureterectomy to treat upper urinary tract urothelial carcinoma. We identified patient-, tumor- and treatment-specific characteristics that should be systematically assessed to guide postoperative decision-making.
CONTEXT: There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC). OBJECTIVE: To assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis. EVIDENCE ACQUISITION: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all reports that included detailed results of multivariate analyses on the predictors of IVR. According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, we selected 18 retrospective studies that each included more than 100 patients treated exclusively with RNU between 2007 and 2014. Cumulative analyses of available hazard ratios (HRs) and their corresponding 95% confidence intervals were conducted using R software to assess the potential predictors of IVR. EVIDENCE SYNTHESIS: Among the 8275 patients included, 2402 (29%) were diagnosed with IVR within a median time of 22.2 mo (range 6.7-56.5). Patient-specific predictors were as follows: male gender (HR 1.37; p<0.001), previous bladder cancer (HR 1.96; p<0.001), and preoperative chronic kidney disease (HR 1.87; p=0.002). Tumor-specific predictors were as follows: positive preoperative urinary cytology (HR 1.56; p<0.001), ureteral location (HR 1.27; p<0.001), multifocality (HR 1.61; p=0.002), invasive pT stage (HR 1.38; p<0.001), and necrosis (HR 2.17; p=0.02). Treatment-specific predictors were as follows: a laparoscopic approach (HR 1.62; p=0.003), extravesical bladder cuff removal (HR 1.22; p=0.02), and positive surgical margins (HR 1.90; p=0.004). CONCLUSIONS: A meta-analysis of available data identified significant predictors of IVR that should be systematically assessed to propose a risk-adapted approach to adjuvant intravesical instillation of chemotherapy and cystoscopic surveillance after RNU. PATIENT SUMMARY: In this report, we looked at the factors linked to intravesical recurrence after radical nephroureterectomy to treat upper urinary tract urothelial carcinoma. We identified patient-, tumor- and treatment-specific characteristics that should be systematically assessed to guide postoperative decision-making.
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