Guo Runqi, Zhu Yuze, Xiong Gengyan, Li Xuesong, Zhang Kai, Zhou Liqun
Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, 100034, China.
BMC Urol. 2018 Apr 10;18(1):24. doi: 10.1186/s12894-018-0336-5.
Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in upper tract urothelial carcinomas (UTUC) and the role of LND has been controversial. We aim to investigate whether patients with LND had improved survival in UTUC patients.
We performed a systematic literature search of PubMed, Embase, and Cochrane library for citations published prior to January 2016, describing LND performed among UTUC patients and conducted a standard meta-analysis of survival outcomes.
Eleven eligible studies containing 7516 patients satisfied the inclusion criteria. Pooled HRs for cancer-specific survival (CSS) and recurrence-free survival (RFS) were 1.17 (P = 0.18) and 1.33 (P = 0.19) respectively. However, the patients in the LND group had more advanced tumour stages and grades (P < 0.001). Further subgroup analysis showed that among muscle-invasive UTUC patients, the pooled HR for CSS and RFS were 1.10 (P = 0.42) and 0.92 (P = 0.72) respectively. Besides, no difference was found in CSS and RFS between pN0 and pNx individuals in overall populations and in patients with muscle-invasive UTUC, while pN+ patients had significantly worse prognosis when compared to pN0 patients.
LND during RNU allows more accurate staging and prediction of survival, but it remains uncertain whether LND independently improves survival in patients with UTUC. However, standard use of LND should be further investigated in a multi-center, prospective evaluation to obtain a definitive statement regarding this matter.
在上尿路尿路上皮癌（UTUC）的根治性肾输尿管切除术（RNU）中，淋巴结清扫术（LND）并非常规操作，其作用一直存在争议。我们旨在研究接受LND的UTUC患者的生存率是否有所提高。
我们对PubMed、Embase和Cochrane图书馆进行了系统的文献检索，以查找2016年1月之前发表的描述UTUC患者中LND的文献，并对生存结果进行了标准的荟萃分析。
11项符合条件的研究共纳入7516例患者，满足纳入标准。癌症特异性生存（CSS）和无复发生存（RFS）的合并风险比分别为1.17（P = 0.18）和1.33（P = 0.19）。然而，LND组患者的肿瘤分期和分级更高（P < 0.001）。进一步的亚组分析表明，在肌层浸润性UTUC患者中，CSS和RFS的合并风险比分别为1.10（P = 0.42）和0.92（P = 0.72）。此外，在总体人群和肌层浸润性UTUC患者中，pN0和pNx个体的CSS和RFS无差异，而pN+患者与pN0患者相比预后明显更差。
RNU期间的LND可实现更准确的分期和生存预测，但LND是否能独立提高UTUC患者的生存率仍不确定。然而，应在多中心前瞻性评估中进一步研究LND的标准应用，以就此问题得出明确结论。
