Nowak Łukasz, Krajewski Wojciech, Łaszkiewicz Jan, Małkiewicz Bartosz, Chorbińska Joanna, Del Giudice Francesco, Mori Keiichiro, Moschini Marco, Kaliszewski Krzysztof, Rajwa Paweł, Laukhtina Ekaterina, Shariat Shahrokh F, Szydełko Tomasz
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland.
Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, 00185 Rome, Italy.
J Clin Med. 2022 Jul 11;11(14):4007. doi: 10.3390/jcm11144007.
Radical nephroureterectomy (RNU) with bladder cuff excision is a standard of care in patients with high-risk upper tract urothelial carcinoma (UTUC). Although several recommendations and guidelines on the delayed treatment of urologic cancers exist, the evidence on UTUC is scarce and ambiguous. The present systematic review aimed to summarize the available evidence on the survival outcomes after deferred RNU in patients with UTUC. A systematic literature search of the three electronic databases (PubMed, Embase, and Cochrane Library) was conducted until 30 April 2022. Studies were found eligible if they reported the oncological outcomes of patients treated with deferred RNU compared to the control group, including those patients treated with RNU without delay. Primary endpoints were cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). In total, we identified seven eligible studies enrolling 5639 patients. Significant heterogeneity in the definition of "deferred RNU" was found across the included studies. Three out of five studies reporting CSS showed that deferring RNU was associated with worse CSS. Furthermore, three out of four studies reporting OS found a negative impact of delay in RNU on OS. One out of three studies reporting RFS found a negative influence of delayed RNU on RFS. While most studies reported a 3 month interval as a significant threshold for RNU delay, some subgroup analyses showed that a safe delay for RNU was less than 1 month in patients with ureteral tumors (UT) or less than 2 months in patients with hydronephrosis. In conclusion, long surgical waiting time for RNU (especially more than 3 months after UTUC diagnosis) could be considered as an important risk factor having a negative impact on oncological outcomes in patients with UTUC; however, the results of the particular studies are still inconsistent. The safe delay for RNU might be shorter in specific subsets of high-risk patients, such as those with UT and/or hydronephrosis at the time of diagnosis. High-quality additional studies are required to establish evidence for valid recommendations.
根治性肾输尿管切除术（RNU）联合膀胱袖口切除术是高危上尿路尿路上皮癌（UTUC）患者的标准治疗方法。尽管存在一些关于泌尿系统癌症延迟治疗的建议和指南，但关于UTUC的证据却很少且不明确。本系统评价旨在总结UTUC患者延期RNU术后生存结局的现有证据。对三个电子数据库（PubMed、Embase和Cochrane图书馆）进行了系统的文献检索，截至2022年4月30日。如果研究报告了延期RNU治疗患者与对照组（包括未延迟接受RNU治疗的患者）相比的肿瘤学结局，则被认为符合纳入标准。主要终点是癌症特异性生存（CSS）、总生存（OS）和无复发生存（RFS）。我们总共确定了7项符合纳入标准的研究，共纳入5639例患者。在所纳入的研究中，“延期RNU”的定义存在显著异质性。在报告CSS的5项研究中，有3项表明延期RNU与较差的CSS相关。此外，在报告OS的4项研究中，有3项发现RNU延迟对OS有负面影响。在报告RFS的3项研究中，有1项发现延期RNU对RFS有负面影响。虽然大多数研究报告3个月的间隔是RNU延迟的一个重要阈值，但一些亚组分析表明，输尿管肿瘤（UT）患者RNU的安全延迟时间小于1个月，肾积水患者小于2个月。总之，RNU的手术等待时间过长（尤其是UTUC诊断后超过3个月）可被视为对UTUC患者肿瘤学结局有负面影响的一个重要危险因素；然而，具体研究结果仍不一致。在特定的高危患者亚组中，如诊断时患有UT和/或肾积水的患者，RNU的安全延迟时间可能更短。需要高质量的额外研究来为有效建议提供证据。
