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Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta‐analysis
Author(s) -
Guo RunQi,
Hong Peng,
Xiong GengYan,
Zhang Lei,
Fang Dong,
Li XueSong,
Zhang Kai,
Zhou LiQun
Publication year - 2018
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.14053
Subject(s) - medicine , ureteroscopy , hazard ratio , urology , confidence interval , meta analysis , ureteral neoplasm , urothelial cancer , bladder cancer , urothelial carcinoma , oncology , ureter , cancer , transitional cell carcinoma
Objectives To investigate whether ureteroscopy ( URS ) before radical nephroureterectomy ( RNU ) for upper tract urothelial carcinomas ( UTUC s) has an impact on oncological outcomes. Patients and Methods We performed a systematic literature search of PubMed, Web of Science, and EMBASE for citations published prior to September 2017 that described URS performed on patients with UTUC and conducted a standard meta‐analysis on survival outcomes. Results Our meta‐analysis included eight eligible studies containing 3975 patients. The results were as follows: cancer‐specific survival ( CSS ; hazard ratio [ HR ] 0.76, 95% confidence interval [ CI ] 0.59–0.99; P = 0.04), overall survival ( OS ; HR 0.76, 95% CI 0.48–1.21; P = 0.24), recurrence‐free survival ( RFS ; HR 0.89, 95% CI 0.69–1.14; P = 0.37), metastasis‐free survival ( MFS ; HR 1.06, 95% CI 0.82–1.36; P = 0.66), and intravesical recurrence‐free survival ( IRFS ; HR 1.51, 95% CI 1.29–1.77; P < 0.001). When excluding previous bladder tumour history, the result for IRFS was a HR of 1.81 (95% CI 1.53–2.13; P < 0.001). Conclusions This meta‐analysis indicated that URS before RNU did not have a negative impact on CSS , OS , RFS , or MFS in patients with UTUC . However, patients were at higher risk of intravesical recurrence after RNU when they had undergone URS before RNU . Further studies are needed to assess the effects of post‐ URS intravesical chemotherapy on intravesical recurrence.