A Systematic Review and Meta-analysis of Clinicopathologic Factors Linked to Intravesical Recurrence After Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma
There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC). To assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis. A computeri...
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| Published in | European urology Vol. 67; no. 6; pp. 1122 - 1133 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Switzerland
Elsevier B.V
01.06.2015
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0302-2838 1873-7560 1873-7560 |
| DOI | 10.1016/j.eururo.2014.11.035 |
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| Abstract | There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC).
To assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis.
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.
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).
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.
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.
Intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma is linked to patient-, tumor-, and treatment-specific factors that should be systematically assessed to adapt further therapeutic strategies and cystoscopic surveillance. |
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| AbstractList | There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC).
To assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis.
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.
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).
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.
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. 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. There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC). To assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis. 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. 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). 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. 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. Intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma is linked to patient-, tumor-, and treatment-specific factors that should be systematically assessed to adapt further therapeutic strategies and cystoscopic surveillance. There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC).CONTEXTThere is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC).To assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis.OBJECTIVETo assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis.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 ACQUISITIONA 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.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).EVIDENCE SYNTHESISAmong 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).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.CONCLUSIONSA 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.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.PATIENT SUMMARYIn 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. |
| Author | Cussenot, Olivier Utard, Guillemette Mozer, Pierre Léon, Priscilla Rouprêt, Morgan Colin, Pierre Seisen, Thomas Shariat, Shahrokh F. Compérat, Eva Granger, Benjamin Renard-Penna, Raphaële |
| Author_xml | – sequence: 1 givenname: Thomas surname: Seisen fullname: Seisen, Thomas organization: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France – sequence: 2 givenname: Benjamin surname: Granger fullname: Granger, Benjamin organization: Academic Department of Public Health and Biostatistics, Pitié-Salpétrière Hospital, Paris, France – sequence: 3 givenname: Pierre surname: Colin fullname: Colin, Pierre organization: Department of Urology, Hôpital Privé de La Louvière, Générale de Santé, Lille, France – sequence: 4 givenname: Priscilla surname: Léon fullname: Léon, Priscilla organization: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France – sequence: 5 givenname: Guillemette surname: Utard fullname: Utard, Guillemette organization: Academic Library of Medicine, Paris Descartes University, Paris, France – sequence: 6 givenname: Raphaële surname: Renard-Penna fullname: Renard-Penna, Raphaële organization: Academic Department of Radiology, Pitié-Salpétrière Hospital, Paris, France – sequence: 7 givenname: Eva surname: Compérat fullname: Compérat, Eva organization: Academic Department of Pathology, Pitié-Salpétrière Hospital, Paris, France – sequence: 8 givenname: Pierre surname: Mozer fullname: Mozer, Pierre organization: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France – sequence: 9 givenname: Olivier surname: Cussenot fullname: Cussenot, Olivier organization: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France – sequence: 10 givenname: Shahrokh F. surname: Shariat fullname: Shariat, Shahrokh F. organization: Academic Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria – sequence: 11 givenname: Morgan surname: Rouprêt fullname: Rouprêt, Morgan email: morgan.roupret@psl.aphp.fr organization: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25488681$$D View this record in MEDLINE/PubMed |
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| Keywords | Bladder neoplasm Recurrence Renal pelvis Urinary tract Ureter Urothelial carcinoma Survival Prognostic |
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| Snippet | There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial... Abstract Context There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper... |
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| SubjectTerms | Biomarkers - blood Bladder neoplasm Female Humans Kidney Neoplasms - pathology Kidney Neoplasms - surgery Male Middle Aged Multivariate Analysis Neoplasm Recurrence, Local - epidemiology Neoplasm Recurrence, Local - prevention & control Neoplasm Staging - statistics & numerical data Nephrectomy - methods Prognosis Prognostic Recurrence Renal Insufficiency, Chronic - epidemiology Renal pelvis Risk Factors Sex Factors Survival Ureter Urinary Bladder Neoplasms - diagnosis Urinary Bladder Neoplasms - epidemiology Urinary Bladder Neoplasms - prevention & control Urinary tract Urinary Tract - pathology Urinary Tract - surgery Urologic Neoplasms - pathology Urologic Neoplasms - surgery Urology Urothelial carcinoma |
| Title | A Systematic Review and Meta-analysis of Clinicopathologic Factors Linked to Intravesical Recurrence After Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma |
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