Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
Center for Geriatrics, Yidu Central Hospital of Weifang, Qingzhou, Shandong, PR China.
PLoS One. 2019 Sep 12;14(9):e0222223. doi: 10.1371/journal.pone.0222223. eCollection 2019.
Hydronephrosis is a common finding in patients with bladder cancer. The aim of the study was to appraise the prognostic value of preoperative hydronephrosis in bladder cancer patients undergoing radical cystectomy.
We conducted a literature search using PubMed and Embase databases in Aug 2018. Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effects models. The primary endpoint was overall survival (OS). Secondary endpoints were cancer-specific survival (CSS) and recurrence-free survival (RFS).
Overall, 13 studies published between 2008 and 2018 including 4,820 patients were selected for the meta-analysis. The age of bladder cancer patients ranged from 27 to 90.4 years, and the overall proportion of males was 72.5%. Preoperative hydronephrosis was reported in 27.4% of patients. The pooled HR was statistically significant for OS (HR, 1.36; 95% CI [1.20-1.55]) and CSS (HR, 1.64; 95% CI [1.33-2.02]), with no heterogeneity among the enrolled studies. Patients with bilateral hydronephrosis showed a poorer CSS compared to those with no hydronephrosis (HR 5.43, 95% CI [3.14-9.40]). However, there was no difference in CSS between no hydronephrosis and unilateral hydronephrosis groups (HR 1.35, 95% CI [0.84-2.14]). Despite a tendency towards poorer RFS (HR, 1.27; 95% CI [0.96-1.96]), the results demonstrated no significant association between presence of preoperative hydronephrosis and RFS after radical cystectomy.
This meta-analysis indicates that preoperative hydronephrosis is significantly associated with poorer OS and CSS after radical cystectomy for patients with bladder cancer. Preoperative hydronephrosis has a stronger effect on CSS in patients with bilateral hydronephrosis. The presence of preoperative hydronephrosis not only predicts prognosis, but may also help to identify patients who benefit the most from neoadjuvant chemotherapy.
肾积水是膀胱癌患者的常见表现。本研究旨在评估膀胱癌患者行根治性膀胱切除术术前肾积水的预后价值。
我们于 2018 年 8 月通过 PubMed 和 Embase 数据库进行文献检索。使用固定效应或随机效应模型计算汇总风险比（HR）及其 95%置信区间（CI）。主要终点为总生存（OS）。次要终点为癌症特异性生存（CSS）和无复发生存（RFS）。
共纳入 2008 年至 2018 年发表的 13 项研究，共纳入 4820 例患者进行荟萃分析。膀胱癌患者年龄为 27 至 90.4 岁，男性总体比例为 72.5%。术前肾积水见于 27.4%的患者。汇总分析显示 OS（HR 1.36；95%CI [1.20-1.55]）和 CSS（HR 1.64；95%CI [1.33-2.02]）的 HR 有统计学意义，且纳入研究间无异质性。与无肾积水患者相比，双侧肾积水患者 CSS 较差（HR 5.43，95%CI [3.14-9.40]）。然而，无肾积水和单侧肾积水组间 CSS 无差异（HR 1.35，95%CI [0.84-2.14]）。尽管 RFS 有变差趋势（HR 1.27；95%CI [0.96-1.96]），但根治性膀胱切除术后术前肾积水与 RFS 之间无显著关联。
本荟萃分析表明，膀胱癌患者行根治性膀胱切除术前肾积水与 OS 和 CSS 显著相关。双侧肾积水患者术前肾积水对 CSS 的影响更强。术前肾积水不仅预示预后，还可能有助于识别最受益于新辅助化疗的患者。
