Vinson Wai-Shun Chan1, Chris Ho Ming Wong2, Yuhong Yuan3, Jeremy Yuen-Chun Teoh4. 1. School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK. 2. Department of Surgery, Prince of Wales Hospital, Hong Kong, China. 3. Department of Medicine, McMaster University, Hamilton, ON, Canada. 4. S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China.
Abstract
OBJECTIVE: To perform a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, investigating the role of lymph node dissection (LND) during nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC); focussing on survival and complication outcomes. METHODS: A comprehensive systematic search was completed using a combination of Medical Subject Headings terms and keywords related to UTUC and LND on multiple databases. Meta-analyses were performed when outcomes were reported under the same definition in two or more studies. Where meta-analysis was not possible, outcomes were reviewed in a narrative manner. RESULTS: A total of 21 studies were included in the qualitative analysis and 11 cohort studies in the quantitative analysis. Our review did not detect significant improvement in recurrence-free survival (RFS) (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.41-1.92), cancer-specific survival (CSS) (HR 0.89, 95% CI 0.54-1.46) and overall survival (OS) (HR 1.10, 95% CI 0.93-1.30). However, when focussing on studies only including patients with pT2/pT3 UTUC, not performing LND significantly worsened RFS (HR 2.83, 95% CI 1.72-4.66). Reports of removing more than eight lymph nodes may also provide prognostic benefits in pN0 patients. The performance of LND was not associated with a higher rate of postoperative complications (risk ratio 1.06, 95% CI 1.00-1.13). CONCLUSION: Overall, LND did not provide additional benefit in RFS, CSS and OS. However, there was a potential benefit in RFS in patients with muscle-invasive and advanced UTUC. LND was also not associated with increased risks of postoperative complications.Abbreviations: CIS: carcinoma in situ; CSS: cancer-specific survival; HR: hazard ratio; LND: lymph node dissection; NU: nephroureterectomy; OS: overall survival; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RFS: recurrence-free survival; RoB, risk of bias; RR: risk ratio; (UT)UC: (upper tract) urothelial carcinoma.
OBJECTIVE: To perform a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, investigating the role of lymph node dissection (LND) during nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC); focussing on survival and complication outcomes. METHODS: A comprehensive systematic search was completed using a combination of Medical Subject Headings terms and keywords related to UTUC and LND on multiple databases. Meta-analyses were performed when outcomes were reported under the same definition in two or more studies. Where meta-analysis was not possible, outcomes were reviewed in a narrative manner. RESULTS: A total of 21 studies were included in the qualitative analysis and 11 cohort studies in the quantitative analysis. Our review did not detect significant improvement in recurrence-free survival (RFS) (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.41-1.92), cancer-specific survival (CSS) (HR 0.89, 95% CI 0.54-1.46) and overall survival (OS) (HR 1.10, 95% CI 0.93-1.30). However, when focussing on studies only including patients with pT2/pT3 UTUC, not performing LND significantly worsened RFS (HR 2.83, 95% CI 1.72-4.66). Reports of removing more than eight lymph nodes may also provide prognostic benefits in pN0 patients. The performance of LND was not associated with a higher rate of postoperative complications (risk ratio 1.06, 95% CI 1.00-1.13). CONCLUSION: Overall, LND did not provide additional benefit in RFS, CSS and OS. However, there was a potential benefit in RFS in patients with muscle-invasive and advanced UTUC. LND was also not associated with increased risks of postoperative complications.Abbreviations: CIS: carcinoma in situ; CSS: cancer-specific survival; HR: hazard ratio; LND: lymph node dissection; NU: nephroureterectomy; OS: overall survival; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RFS: recurrence-free survival; RoB, risk of bias; RR: risk ratio; (UT)UC: (upper tract) urothelial carcinoma.
Authors: Claudio Jeldres; Maxine Sun; Hendrik Isbarn; Giovanni Lughezzani; Lars Budäus; Ahmed Alasker; Shahrohk F Shariat; Jean-Baptiste Lattouf; Hugues Widmer; Daniel Pharand; Philippe Arjane; Markus Graefen; Francesco Montorsi; Paul Perrotte; Pierre I Karakiewicz Journal: Urology Date: 2009-12-06 Impact factor: 2.649
Authors: Thomas Knoll; Muhammad Imran Omar; Steven Maclennan; Virginia Hernández; Steven Canfield; Yuhong Yuan; Max Bruins; Lorenzo Marconi; Hein Van Poppel; James N'Dow; Richard Sylvester Journal: Eur Urol Date: 2017-09-13 Impact factor: 20.096
Authors: Francesco Soria; Shahrokh F Shariat; Seth P Lerner; Hans-Martin Fritsche; Michael Rink; Wassim Kassouf; Philippe E Spiess; Yair Lotan; Dingwei Ye; Mario I Fernández; Eiji Kikuchi; Daher C Chade; Marko Babjuk; Arthur P Grollman; George N Thalmann Journal: World J Urol Date: 2016-09-07 Impact factor: 4.226
Authors: Jonathan J Melquist; Grant Redrow; Scott Delacroix; Andrew Park; Eliney E Faria; Jose A Karam; Surena F Matin Journal: Urology Date: 2015-10-19 Impact factor: 2.649
Authors: Kang Su Cho; Hyun Min Choi; Kyochul Koo; Sung Jin Park; Koon Ho Rha; Young Deuk Choi; Byung Ha Chung; Nam Hoon Cho; Seung Choul Yang; Sung Joon Hong Journal: J Korean Med Sci Date: 2009-07-29 Impact factor: 2.153