Yoo Sang Hyun, Jeong Chang Wook, Kwak Cheol, Kim Hyeon Hoe, Choo Min Soo, Ku Ja Hyeon
Department of Urology, Seoul National University Hospital, Seoul 03080, Korea,.
Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea.
J Clin Med. 2019 Jul 19;8(7):1059. doi: 10.3390/jcm8071059.
The aim of this study was to determine the prophylactic effect of intravesical chemotherapy. Furthermore, it aimed to compare the efficacy of regimens on the prevention of bladder recurrence, after nephroureterectomy, for upper tract urothelial carcinoma by systematic review and network meta-analysis. A comprehensive literature search was conducted to search for studies published before 22 December 2016 using PubMed, Embase, and Scopus. All studies comparing nephroureterectomy alone with prophylactic intravesical chemotherapy after nephroureterectomy were included. The primary outcome was intravesical recurrence-free survival rate. In addition, we conducted indirect comparisons among regimens using network meta-analysis, as well as three randomized controlled trials (RCTs) on multicenter setting, and one large retrospective study with a total of 532 patients were analyzed. The pooled hazard ratio (HR) of bladder recurrence was 0.54 (95% CI: 0.38-0.76) in intravesical instillation patients. On network meta-analysis, pirarubicin was ranked the most effective regimen, while maintenance therapy of mitomycin C (MMC) with Ara-C and induction therapy of MMC were ranked as the second and third most effective regimens, respectively. Our study demonstrates that intravesical chemotherapy can prevent bladder recurrence in patients with upper tract urothelial carcinoma after nephroureterectomy. It also suggests that a single instillation of pirarubicin is the most efficacious intravesical regimen.
本研究的目的是确定膀胱内化疗的预防效果。此外，旨在通过系统评价和网状Meta分析，比较肾输尿管切除术后不同方案对上尿路尿路上皮癌膀胱复发的预防疗效。通过使用PubMed、Embase和Scopus对2016年12月22日前发表的研究进行全面文献检索。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。主要结局是膀胱无复发生存率。此外，我们使用网状Meta分析对不同方案进行间接比较，以及对三项多中心随机对照试验（RCT）和一项共532例患者的大型回顾性研究进行分析。膀胱内灌注患者膀胱复发的合并风险比（HR）为0.54（95%CI：0.38 - 0.76）。在网状Meta分析中，吡柔比星被列为最有效的方案，而丝裂霉素C（MMC）与阿糖胞苷的维持治疗和MMC的诱导治疗分别被列为第二和第三有效的方案。我们的研究表明，膀胱内化疗可预防肾输尿管切除术后上尿路尿路上皮癌患者的膀胱复发。这也表明，单次灌注吡柔比星是最有效的膀胱内治疗方案。
