Department of Urology and Oncologic Urology, Lower Silesian Specialist Hospital, Fieldorfa 2 Street, 50-556, Wroclaw, Poland.
Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland.
World J Surg Oncol. 2021 Apr 21;19(1):129. doi: 10.1186/s12957-021-02236-z.
During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU.
The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled.
Eighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60-1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62-1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85-1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94-1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter.
Our present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions.
在过去的二十年中，腹腔镜根治性肾输尿管切除术（LRNU）已被提议作为开放根治性肾输尿管切除术（ORNU）的替代技术，并且越来越多地被接受用于治疗上尿路尿路上皮癌（UTUC）患者。然而，LRNU 的肿瘤学疗效仍存在争议，尤其是对于局部晚期（T3/T4 和/或 N+）UTUC 的治疗。在这项荟萃分析中，我们旨在累积比较 LRNU 与 ORNU 的肿瘤学结果。
本荟萃分析根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。对三个电子数据库（Medline、Embase 和 Cochrane Library）进行了搜索。提取并汇总了癌症特异性生存（CSS）、总生存（OS）、膀胱内无复发生存率（IVRFS）和无复发生存率（RFS）的测量结果，包括风险比（HR）和 95%置信区间（CI）。
2007 年至 2020 年共纳入 18 篇文章进行最终定量分析。其中一项研究为随机对照试验（RCT），其余文章均为回顾性设计。在所选论文的总共 10730 名参与者中，分别有 5959 名（55.5%）和 4771 名（44.5%）接受了 ORNU 和 LRNU。汇总分析结果显示，LRNU 和 ORNU 组在 CSS（HR 0.84，95%CI 0.60-1.19，p=0.33）、OS（HR 0.84，95%CI 0.62-1.13，p=0.25）、IVRFS（HR 1.08，95%CI 0.85-1.39，p=0.52）和 RFS（HR 1.09，95%CI 0.94-1.25，p=0.26）方面无显著差异。此外，对于 pT3/T4 和 pTany N+人群的亚组分析结果也未证实 LRNU 和 ORNU 在任何生存参数方面存在统计学差异。
我们对当前证据的荟萃分析表明，LRNU 和 ORNU 在 UTUC 患者中的肿瘤学结果相当，即使在局部晚期疾病患者中也是如此。需要进行具有更大样本量和针对具体手术程序（如膀胱袖状切除）的统一数据的多中心 RCT，以得出明确的结论。
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