Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris; Pierre et Marie Curie Medical School, University Paris 6, Paris, France.
Department of Urology, University of Rennes, Rennes, France.
Eur Urol. 2016 Dec;70(6):1052-1068. doi: 10.1016/j.eururo.2016.07.014. Epub 2016 Jul 28.
There is uncertainty regarding the oncologic effectiveness of kidney-sparing surgery (KSS) compared with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
To systematically review the current literature comparing oncologic outcomes of KSS versus RNU for UTUC.
A computerised bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting comparative oncologic outcomes of KSS versus RNU. Approaches considered for KSS were segmental ureterectomy (SU) and ureteroscopic (URS) or percutaneous (PC) management. Using the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we identified 22 nonrandomised comparative retrospective studies published between 1999 and 2015 that were eligible for inclusion in this systematic review. A narrative review and risk-of-bias (RoB) assessment were performed using cancer-specific survival (CSS) as the primary end point.
Seven studies compared KSS overall (n=547) versus RNU (n=1376). Information on the comparison of SU (n=586) versus RNU (n=3692), URS (n=162) versus RNU (n=367), and PC (n=66) versus RNU (n=114) was available in 10, 5, and 2 studies, respectively. No significant difference was found between SU and RNU in terms of CSS or any other oncologic outcomes. Only patients with low-grade and noninvasive tumours experienced similar CSS after URS or PC when compared with RNU, despite an increased risk of local recurrence following endoscopic management of UTUC. The RoB assessment revealed, however, that the analyses were subject to a selection bias favouring KSS.
Our systematic review suggests similar survival after KSS versus RNU only for low-grade and noninvasive UTUC when using URS or PC. However, selected patients with high-grade and invasive UTUC could safely benefit from SU when feasible. These results should be interpreted with caution due to the risk of selection bias.
We reviewed the studies that compared kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma. We found similar oncologic outcomes for favourable tumours when using ureteroscopic or percutaneous management, whereas indications for segmental ureterectomy could be extended to selected cases of aggressive tumours.
与根治性肾输尿管切除术（RNU）相比，保留肾单位手术（KSS）治疗上尿路上皮癌（UTUC）的肿瘤学效果尚不确定。
系统综述比较 KSS 与 RNU 治疗 UTUC 的肿瘤学结果的现有文献。
对 Medline、Embase 和 Cochrane 数据库进行计算机检索，检索所有报告 KSS 与 RNU 比较肿瘤学结果的研究。KSS 的治疗方法包括节段性输尿管切除术（SU）和输尿管镜（URS）或经皮（PC）处理。根据系统评价和荟萃分析首选报告项目的方法，我们确定了 1999 年至 2015 年间发表的 22 项非随机比较回顾性研究，这些研究符合本系统综述的纳入标准。使用癌症特异性生存（CSS）作为主要终点，进行叙述性综述和风险偏倚（RoB）评估。
有 7 项研究比较了 KSS 总体（n=547）与 RNU（n=1376）。SU（n=586）与 RNU（n=3692）、URS（n=162）与 RNU（n=367）和 PC（n=66）与 RNU（n=114）比较的信息分别在 10、5 和 2 项研究中获得。SU 和 RNU 在 CSS 或任何其他肿瘤学结果方面没有显著差异。只有低级别和非浸润性肿瘤的患者在接受 URS 或 PC 治疗后与 RNU 具有相似的 CSS，但内镜治疗 UTUC 后局部复发的风险增加。然而，RoB 评估表明，分析受到有利于 KSS 的选择偏倚的影响。
我们的系统综述表明，仅在使用 URS 或 PC 治疗低级别和非浸润性 UTUC 时，KSS 与 RNU 的生存率相似。然而，对于可行的高危和侵袭性 UTUC 患者，可安全受益于 SU。由于存在选择偏倚的风险，应谨慎解释这些结果。
我们综述了比较保留肾单位手术与根治性肾输尿管切除术治疗上尿路上皮癌的研究。我们发现，对于使用输尿管镜或经皮处理的有利肿瘤，肿瘤学结果相似，而节段性输尿管切除术的适应证可扩展至选定的侵袭性肿瘤病例。
