EPROAD research laboratory (EA 4669), Amiens, France; Department of urology and transplantation, Picardie Jules-Verne university, Amiens, France.
Department of urology and transplantation, Paris Diderot university, Saint-Louis hospital, Paris, France.
Prog Urol. 2021 May;31(6):303-315. doi: 10.1016/j.purol.2020.09.020. Epub 2021 Feb 13.
Achieving negative status of distal ureteral margin at the time of radical cystectomy (RC), and its therapeutic benefit, remains controversial. The aim of this review was to evaluate frequency, reliability and impact of positive distal ureteral margin after radical cystectomy for bladder cancer on upper tract recurrence, cancer specific and overall survival, and to identify best candidates for intraoperative frozen section analyses.
A systemic review was performed following the PRISMA guideline. PubMed/Medline (with following terms; bladder cancer or cystectomy and frozen section or ureteral margin), and Cochrane Library were searched up to April 2020, to identify all papers evaluating distal ureteral margin and discussing clinical interest. Previous reviews and single case reports were excluded.
In total, thirty-two relevant studies were identified. Mean rate of positive ureteral frozen section after RC was close to 10% [1.1-25.4%]. Frozen section (FS) achieved a very good specificity [83-100%] and reserved sensibility [45-100%]. In many cases, an initial positive margin on FS can be converted to negative. Positive FS and/or PS (permanent section) were associated with upper urinary tract recurrence (UUTR). Conversion from positive FS to negative PS was associated with low UUTR frequency and better cancer survival in large retrospective studies. The relevant prognostic factor associated with positive FS and/or PS was CIS within the bladder.
FS should be recommended for patients with CIS within the bladder. Achieving negative FS/PS might be associated with lower rates of UUTR and better survival, for patients with higher life expectancy. Prospective randomized controlled studies need to be performed to provide definitive recommendations in this area.
在根治性膀胱切除术 (RC) 时达到远端输尿管切缘阴性状态及其治疗益处仍存在争议。本综述的目的是评估膀胱癌根治性膀胱切除术后远端输尿管切缘阳性的频率、可靠性和对上尿路复发、癌症特异性和总生存的影响，并确定术中冷冻切片分析的最佳候选者。
按照 PRISMA 指南进行系统评价。检索 PubMed/Medline（以下列术语；膀胱癌或膀胱切除术和冷冻切片或输尿管边缘）和 Cochrane Library，以确定所有评估远端输尿管边缘并讨论临床意义的论文。排除了以前的综述和单个病例报告。
共确定了 32 项相关研究。RC 后远端输尿管冷冻切片阳性的平均率接近 10%[1.1-25.4%]。冷冻切片 (FS) 具有非常好的特异性[83-100%]和保留的敏感性[45-100%]。在许多情况下，FS 上的初始阳性切缘可以转为阴性。FS 和/或 PS（永久切片）阳性与上尿路复发 (UUTR) 相关。在大型回顾性研究中，从 FS 阳性转为 PS 阴性与 UUTR 频率较低和癌症生存较好相关。与 FS 和/或 PS 阳性相关的相关预后因素是膀胱内 CIS。
对于膀胱内 CIS 的患者，应推荐 FS。对于预期寿命较长的患者，FS/PS 阴性可能与较低的 UUTR 发生率和更好的生存相关。需要进行前瞻性随机对照研究，以在该领域提供明确的建议。
