Qiu Dongxu, Hu Jiao, He Tongchen, Li Huihuang, Hu Jian, Yi Zhenglin, Chen Jinbo, Zu Xiongbing
Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
Transl Androl Urol. 2020 Oct;9(5):2094-2106. doi: 10.21037/tau-20-933.
The outcome of neoadjuvant chemotherapy (NAC) has been established in bladder cancer but remains controversial in upper tract urothelial carcinoma (UTUC). In this work, we explored the therapeutic effect of NAC in patients with locally advanced UTUC.
We conducted a literature search on articles published from 1995 up to April 2020 in PubMed/Medline, the Cochrane Library, Embase, Google Scholar. A total of 19 eligible studies with 6,283 patients were identified, from which the overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), disease-free survival (DFS), pathological complete response (pCR) rate and pathological partial response (pPR) rate were extracted. All analyses were conducted using Review Manager 5.3 and Stata statistical software (version 15).
In total, 6,283 UTUC patients were included from 19 eligible studies out of which 1,474 patients received NAC and subsequent radical nephroureterectomy (RNU), whereas 4,809 patients received RNU only. Compared with single RNU, patients with NAC and subsequent RNU exhibited longer OS, CSS, PFS, DFS by hazard ratio (HR) 2.14 [95% confidence interval (CI): 1.75-2.63; P<0.001], HR 2.07 (95% CI: 1.49-2.87; P<0.001), HR 2.00 (95% CI: 1.42-2.83; P<0.001), and HR 3.76 (95% CI: 2.16-6.56; P<0.001). pCR rate and pPR rate of NAC are 0.10 (0.07-0.13) and 0.40 (95% CI: 0.32-0.49, P <0.001) respectively.
This work revealed that NAC and subsequent RNU provided better survival outcomes in patients with locally advanced UTUC when compared with single RNU.
新辅助化疗（NAC）在膀胱癌中的疗效已得到确立，但在上尿路尿路上皮癌（UTUC）中仍存在争议。在本研究中，我们探讨了NAC对局部晚期UTUC患者的治疗效果。
我们在PubMed/Medline、Cochrane图书馆、Embase、谷歌学术上检索了1995年至2020年4月发表的文章。共纳入19项符合条件的研究，涉及6283例患者，从中提取总生存期（OS）、癌症特异性生存期（CSS）、无进展生存期（PFS）、无病生存期（DFS）、病理完全缓解（pCR）率和病理部分缓解（pPR）率。所有分析均使用Review Manager 5.3和Stata统计软件（版本15）进行。
总共从19项符合条件的研究中纳入了6283例UTUC患者，其中1474例患者接受了NAC及随后的根治性肾输尿管切除术（RNU），而4809例患者仅接受了RNU。与单纯RNU相比，接受NAC及随后RNU的患者的OS、CSS、PFS、DFS更长，风险比（HR）分别为2.14[95%置信区间（CI）：1.75-2.63；P<0.001]、HR 2.07（95%CI：1.49-2.87；P<0.001）、HR 2.00（95%CI：1.42-2.83；P<0.001）和HR 3.76（95%CI：2.16-6.56；P<0.001）。NAC的pCR率和pPR率分别为0.10（0.07-0.13）和0.40（95%CI：0.32-0.49，P<0.001）。
本研究表明，与单纯RNU相比，NAC及随后的RNU为局部晚期UTUC患者提供了更好的生存结果。
