Ma Runzhuo, Liu Zenan, Cheng Yinchu, Zhou Pengxiang, Pan Yuting, Bi Hai, Tao Liyuan, Yang Bin, Xia Haizhui, Zhu Xuehua, He Jide, He Wei, Wang Guoliang, Huang Yi, Ma Lulin, Lu Jian
Department of Urology, Peking University Third Hospital, Beijing, China.
Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
Eur Urol Open Sci. 2022 Jun 28;42:19-29. doi: 10.1016/j.euros.2022.06.001. eCollection 2022 Aug.
The role of tumor size in predicting prognosis in upper tract urothelial carcinoma (UTUC) patients remains poorly defined.
To assess the prognostic value of tumor size in patients with UTUC through a systematic review and meta-analysis.
A comprehensive literature search of the PubMed and Embase databases were performed to identify all relevant articles published up to December 2021 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Available hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were analyzed to evaluate the association between tumor size and survival outcomes.
A total of 35 articles representing 32 292 patients met the eligibility criteria and were finally included for the meta-analysis. Tumor size was significantly associated with poor outcomes in terms of overall survival (HR = 1.42, 95% CI = 1.28-1.58), cancer-specific survival (HR = 1.66, 95% CI = 1.47-1.88), recurrence-free survival (HR = 1.25, 95% CI = 1.13-1.38), and intravesical recurrence (HR = 1.12, 95% CI = 1.04-1.20). There was between-study heterogeneity in the effect of tumor size on all these meta-analyses, with < 0.10 and I generally >50%. Subgroup analyses illustrated that the association of tumor size with adverse prognosis in UTUC patients is not affected by treatment modalities. Segmental resection of ureter, whether receiving lymph node dissection, cutoff of tumor size, and region of population were potential sources of heterogeneity. The funnel plot test indicated no significant publication bias in the meta-analysis of survival outcomes.
This study shows that larger tumor size is associated with an increased risk of overall and cancer-specific mortality, and disease recurrence in UTUC. Integration of tumor size with other prognostic indicators may help in risk stratification and individualized treatment of UTUC.
Through a systematic review and meta-analysis, this study found that larger tumor size is associated with an increased risk of overall and cancer-specific mortality, and disease recurrence in patients with upper tract urothelial carcinoma.
肿瘤大小在上尿路尿路上皮癌（UTUC）患者预后预测中的作用仍未明确界定。
通过系统评价和荟萃分析评估肿瘤大小在UTUC患者中的预后价值。
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明，对PubMed和Embase数据库进行全面文献检索，以识别截至2021年12月发表的所有相关文章。分析可用的风险比（HRs）和相应的95%置信区间（95% CIs），以评估肿瘤大小与生存结果之间的关联。
共有35篇文章代表32292例患者符合纳入标准，最终纳入荟萃分析。肿瘤大小在总生存（HR = 1.42，95% CI = 1.28 - 1.58）、癌症特异性生存（HR = 1.66，95% CI = 1.47 - 1.88）、无复发生存（HR = 1.25，95% CI = 1.13 - 1.38）和膀胱内复发（HR = 1.12，95% CI = 1.04 - 1.20）方面与不良结局显著相关。在所有这些荟萃分析中，肿瘤大小的效应存在研究间异质性，I² < 0.10且I一般>50%。亚组分析表明，UTUC患者中肿瘤大小与不良预后的关联不受治疗方式影响。输尿管节段性切除，无论是否接受淋巴结清扫、肿瘤大小截断以及人群区域，都是异质性的潜在来源。漏斗图检验表明，在生存结果的荟萃分析中无显著发表偏倚。
本研究表明，较大的肿瘤大小与UTUC患者的总体和癌症特异性死亡风险增加以及疾病复发相关。将肿瘤大小与其他预后指标相结合可能有助于UTUC的风险分层和个体化治疗。
通过系统评价和荟萃分析，本研究发现较大的肿瘤大小与上尿路尿路上皮癌患者的总体和癌症特异性死亡风险增加以及疾病复发相关。
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