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Impact of diagnostic ureteroscopy on intravesical recurrence in patients undergoing radical nephroureterectomy for upper tract urothelial cancer: a systematic review and meta‐analysis
Author(s) -
Marchioni Michele,
Primiceri Giulia,
Cindolo Luca,
Hampton Lance J.,
Grob Mayer B.,
Guruli Georgi,
Schips Luigi,
Shariat Shahrokh F.,
Autorino Riccardo
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13935
Subject(s) - medicine , ureteroscopy , meta analysis , hazard ratio , urothelial carcinoma , confidence interval , urology , random effects model , bladder cancer , oncology , cancer , surgery , ureter
Aim of this study was to analyse the association between the use of diagnostic ureteroscopy ( URS ) and the development of intravesical recurrence ( IVR ) in patients undergoing radical nephroureterectomy ( RNU ) for high‐risk upper tract urothelial carcinoma. A systematic review of the published data was performed up to December 2016, using multiple search engines to identify eligible studies. A formal meta‐analysis was conducted of studies comparing patients who underwent URS before RNU with those who did not. Hazard ratios ( HR s), with their 95% confidence intervals ( CI s), from each study were used to calculate pooled HR s. Pooled estimates were calculated using a fixed‐effects or random‐effects model according to heterogeneity. Statistical analyses were performed using RevMan , version 5. Seven studies were included in the systematic review, but only six of these were deemed fully eligible for meta‐analysis. Among the 2 382 patients included in the meta‐analysis, 765 underwent diagnostic URS prior to RNU . All examined studies were retrospective, and the majority examined Asian populations. The IVR rate ranged from 39.2% to 60.7% and from 16.7% to 46% in patients with and without prior URS , respectively. In the pooled analysis, a statistically significant association was found between performance of URS prior to RNU and IVR ( HR 1.56, 95% CI 1.33–1.88; P < 0.001). There was no heterogeneity in the observed outcomes, according to the I 2 statistic of 2% ( P = 0.40). Within the intrinsic limitations of this type of analysis, these findings suggest a significant association between the use of diagnostic URS and higher risk of developing IVR after RNU . Further research in this area should be encouraged to further investigate the possible causality behind this association and it potential clinical implications.