Yuan Haichao, Mao Xiangming, Bai Yunjin, Li Hengping, Liu Liangren, Pu Chunxiao, Li Jinhong, Tang Yin, Wei Qiang, Han Ping
J Chemother. 2015 Aug;27(4):195-200. doi: 10.1179/1973947815Y.0000000034. Epub 2015 May 13.
The standard management of upper urinary tract urothelial carcinoma (UUT-UC) is nephroureterectomy with bladder cuff excision, but after surgery, approximately 22-47% of patients with UUT-UC develop subsequent bladder tumour recurrence, potentially because of the implantation of cancer cells from the primary tumour.
To conduct a meta-analysis to evaluate the effect of prophylactic intravesical chemotherapy in the prevention of bladder recurrence after nephroureterectomy for UUT-UC.
An electronic database search of Medline, Embase, the Cochrane Library, CancerLit and ClinicalTrials.gov was performed to identify appropriate studies prior to March 2013.All studies comparing nephroureterectomy alone with prophylactic intravesical chemotherapy after nephroureterectomy were included. The main outcome measure for this meta-analysis was the rate of bladder recurrence after nephroureterectomy. The search was not limited by language. The review process followed the guidelines of the Cochrane Collaboration. The analysis was conducted using the Review Manager Version RevMan 5.0 software (The Nordic Cochrane Centre, The Cochrane Collaboration).
A total of 592 patients were included in this study, of whom 257 underwent intravesical instillation after nephroureterectomy and 335 underwent nephroureterectomy alone. Our meta-analysis demonstrated that the rate of recurrence after 12 months was significantly lower in the intravesical instillation after nephroureterectomy group than in the nephroureterectomy-alone group [odds ratio (OR): 0.48; 95% confidence interval (CI): 0.28-0.81; P = 0.006]. A significant decrease in bladder recurrence after at least 24 months was also observed in the intravesical instillation after nephroureterectomy group (OR: 0.40; 95% CI: 0.24-0.67; P = 0.0004). A subgroup analysis demonstrated that the pattern of differences was similar to those from the total group analysis.
Prophylactic intravesical chemotherapy was effective for the prevention of bladder recurrence after nephroureterectomy. Therefore, we suggest that prophylactic intravesical chemotherapy should be performed in patients with UUT-UC after nephroureterectomy, but the optimal chemotherapy regimen and the initial time of instillation should be explored in future studies.
上尿路尿路上皮癌（UUT-UC）的标准治疗方法是肾输尿管切除术加膀胱袖口切除术，但术后约22%-47%的UUT-UC患者会出现膀胱肿瘤复发，这可能是由于原发肿瘤癌细胞的种植。
进行一项荟萃分析，以评估预防性膀胱内化疗在预防UUT-UC肾输尿管切除术后膀胱复发中的作用。
在2013年3月之前，对Medline、Embase、Cochrane图书馆、CancerLit和ClinicalTrials.gov进行电子数据库检索，以确定合适的研究。纳入所有比较单纯肾输尿管切除术与肾输尿管切除术后预防性膀胱内化疗的研究。该荟萃分析的主要结局指标是肾输尿管切除术后膀胱复发率。检索不受语言限制。综述过程遵循Cochrane协作网的指南。使用Review Manager版本RevMan 5.0软件（北欧Cochrane中心，Cochrane协作网）进行分析。
本研究共纳入592例患者，其中257例在肾输尿管切除术后接受膀胱内灌注，335例仅接受肾输尿管切除术。我们的荟萃分析表明，肾输尿管切除术后膀胱内灌注组12个月后的复发率显著低于单纯肾输尿管切除术组[比值比（OR）：0.48；95%置信区间（CI）：0.28-0.81；P = 0.006]。肾输尿管切除术后膀胱内灌注组在至少24个月后膀胱复发也显著减少（OR：0.40；95%CI：0.24-0.67；P = 0.0004）。亚组分析表明，差异模式与全组分析相似。
预防性膀胱内化疗对预防肾输尿管切除术后膀胱复发有效。因此，我们建议UUT-UC患者在肾输尿管切除术后应进行预防性膀胱内化疗，但最佳化疗方案和初始灌注时间应在未来研究中探索。
