Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China.
Department of Pharmacy, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China.
BMC Cancer. 2019 Jul 19;19(1):716. doi: 10.1186/s12885-019-5924-6.
Assessing the prognostic significance of specific clinicopathological features plays an important role in surgical management after radical cystectomy. This study investigated the association between ten clinicopathological characteristics and cancer-specific survival (CSS) in patients with bladder cancer.
In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a literature search was conducted through the PubMed, EMBASE and Web of Science databases using appropriate search terms from the dates of inception until November 2018. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the CSS. Fixed- or random-effects models were constructed according to existence of heterogeneity.
Thirty-three articles met the eligibility criteria for this systematic review, which included 19,702 patients. The overall results revealed that CSS was associated with advanced age (old vs. young: pooled HR = 1.01; 95% CI:1.00-1.01; P < 0.001), higher tumor grade (3 vs. 1/2: pooled HR = 1.29; 95% CI:1.15-1.45; P < 0.001), higher pathological stage (3/4 vs. 1/2: pooled HR = 1.60; 95% CI:1.37-1.86; P < 0.001), lymph node metastasis (positive vs. negative: pooled HR = 1.51; 95% CI:1.37-1.67; P < 0.001), lymphovascular invasion (positive vs. negative: pooled HR = 1.36; 95% CI:1.28-1.45; P < 0.001), and soft tissue surgical margin (positive vs. negative: pooled HR = 1.42; 95% CI:1.30-1.56; P < 0.001). However, gender (male vs. female: pooled HR = 0.98; 95% CI: 0.96-1.01; P = 0.278), carcinoma in situ (positive vs. negative: pooled HR = 0.98; 95% CI: 0.88-1.10; P = 0.753), histology (transitional cell cancer vs variant: pooled HR = 0.90; 95% CI: 0.79-1.02; P = 0.089) and adjuvant chemotherapy (yes vs. no: pooled HR = 1.16; 95% CI: 1.00-1.34; P = 0.054) did not affect CSS after radical resection of bladder cancer.
Our results revealed that several clinicopathological characteristics can predict CSS risk after radical cystectomy. Prospective studies are needed to further confirm the predictive value of these variables for the prognosis of bladder cancer patients after radical cystectomy.
评估特定临床病理特征的预后意义在根治性膀胱切除术后的手术管理中起着重要作用。本研究调查了膀胱癌患者的十种临床病理特征与癌症特异性生存（CSS）之间的关系。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，通过 PubMed、EMBASE 和 Web of Science 数据库使用适当的搜索词从成立日期到 2018 年 11 月进行文献检索。使用 95%置信区间（CI）计算合并危险比（HR）来评估 CSS。根据是否存在异质性，构建固定或随机效应模型。
33 篇文章符合本系统评价的纳入标准，共纳入 19702 名患者。总体结果表明，CSS 与年龄较大（老年与年轻：合并 HR=1.01；95%CI：1.00-1.01；P<0.001）、肿瘤分级较高（3 级与 1/2 级：合并 HR=1.29；95%CI：1.15-1.45；P<0.001）、病理分期较高（3/4 级与 1/2 级：合并 HR=1.60；95%CI：1.37-1.86；P<0.001）、淋巴结转移（阳性与阴性：合并 HR=1.51；95%CI：1.37-1.67；P<0.001）、脉管侵犯（阳性与阴性：合并 HR=1.36；95%CI：1.28-1.45；P<0.001）和软组织手术边缘（阳性与阴性：合并 HR=1.42；95%CI：1.30-1.56；P<0.001）有关。然而，性别（男性与女性：合并 HR=0.98；95%CI：0.96-1.01；P=0.278）、原位癌（阳性与阴性：合并 HR=0.98；95%CI：0.88-1.10；P=0.753）、组织学（移行细胞癌与变异型：合并 HR=0.90；95%CI：0.79-1.02；P=0.089）和辅助化疗（是与否：合并 HR=1.16；95%CI：1.00-1.34；P=0.054）不能影响膀胱癌根治性切除术后的 CSS。
我们的研究结果表明，一些临床病理特征可以预测根治性膀胱切除术后的 CSS 风险。需要前瞻性研究进一步证实这些变量对膀胱癌患者根治性膀胱切除术后预后的预测价值。
