Yang Xiao, Li Peng, Deng Xiaheng, Dong Hongquan, Cheng Yidong, Zhang Xiaolei, Yang Chengdi, Tang Jingyuan, Yuan Wenbo, Xu Xiaoting, Tao Jun, Li Pengchao, Yang Haiwei, Lu Qiang, Gu Min, Wang Zengjun
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Oncotarget. 2017 Jan 10;8(2):3568-3580. doi: 10.18632/oncotarget.12239.
Perioperative treatments have been used to improve prognosis in patients with upper tract urothelial carcinoma (UTUC). However, optimal management remains unestablished.
We searched the Embase, Web of Science and Cochrane databases for studies published before June 20, 2015. All included studies were categorised into three groups on the basis of the outcome reported (overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS)). Relative hazard ratios (HRs) for death were calculated using random-effects Bayesian network meta-analysis methods. We also ranked the three different treatments in terms of three outcomes.
A total of 31 trials with 8100 patients were included. Compared with the control, adjuvant chemotherapy (AC) could improve OS, DSS and RFS by 32% (HR 0.68, 95% CI 0.51-0.89), 29% (HR 0.71, 95% CI 0.54-0.89) and 51% (HR 0.49, 95% CI 0.23-0.85), respectively. We noted a marked prolongation of RFS in both intravesical chemotherapy (HR 0.32, 95% CI 0.09-0.69) as well as concurrent radiotherapy and intravesical chemotherapy (HR 0.32, 95% CI 0.03-0.97) than in the control. Neoadjuvant chemotherapy (NAC) showed a significant improvement in DSS relative to the control (HR 0.25, 95% CI 0.06-0.61) and a distinct advantage over AC (HR 0.36, 95% CI 0.08-0.90) or AR (HR 6.89, 95% CI 1.25-18.66).
Our results showed that AC; intravesical chemotherapy; and concurrent radiotherapy and intravesical chemotherapy could improve the prognosis of UTUC patients. NAC was found to be more favourable for UTUC than AC in terms of DSS.
围手术期治疗已被用于改善上尿路尿路上皮癌（UTUC）患者的预后。然而，最佳治疗方案仍未确定。
我们检索了Embase、Web of Science和Cochrane数据库中2015年6月20日前发表的研究。所有纳入研究根据报告的结局（总生存期（OS）、疾病特异性生存期（DSS）和无复发生存期（RFS））分为三组。使用随机效应贝叶斯网络荟萃分析方法计算死亡的相对风险比（HRs）。我们还根据三种结局对三种不同治疗进行了排名。
共纳入31项试验，涉及8100例患者。与对照组相比，辅助化疗（AC）可使OS、DSS和RFS分别提高32%（HR 0.68，95%CI 0.51-0.89）、29%（HR 0.71，95%CI 0.54-0.89）和51%（HR 0.49，95%CI 0.23-0.85）。我们注意到，与对照组相比，膀胱内化疗（HR 0.32，95%CI 0.09-0.69）以及同步放疗和膀胱内化疗（HR 0.32，95%CI 0.03-0.97）的RFS均有显著延长。新辅助化疗（NAC）相对于对照组在DSS方面有显著改善（HR 0.25，95%CI 0.06-0.61），并且相对于AC（HR 0.36，95%CI 0.08-0.90）或AR（HR 6.89，95%CI 1.25-18.66）具有明显优势。
我们的结果表明，AC、膀胱内化疗以及同步放疗和膀胱内化疗可改善UTUC患者的预后。就DSS而言，发现NAC对UTUC比AC更有利。
