Zhang Guanlan, Jiang Zhaoqiang, Chen Jiawei, Zhao Ying, Wang Jianan, Liu Jinxing, Ding Zhenshan, Shan Lei
Urology Department, Henan Provincial People's Hospital, Zhengzhou, China.
Department of Medicine, Graduate School, Henan University, Kaifeng, China.
Front Oncol. 2024 Nov 26;14:1475044. doi: 10.3389/fonc.2024.1475044. eCollection 2024.
Numerous studies have investigated predictors of intravesical recurrence following radical nephrectomy (RNU) in patients with upper urinary tract uroepithelial carcinoma (UTUC). In contrast, extravesical recurrence (EUR) has received less focus. Consequently, this study aims to evaluate the significant predictors of EUR after RNU through a systematic review of the literature and a meta-analysis.
We conducted a computerized bibliographic search across PubMed, Embase, and Cochrane databases to identify reports that include detailed results from multivariate analyses of predictors of EUR. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) criteria, we selected thirteen retrospective studies, each with a sample size exceeding 100 cases. Using Review Manager 5.4 software, we performed cumulative analyses of available HR and their corresponding 95% confidence intervals to evaluate potential predictors of EUR.
Our findings indicate that patient-specific predictors include preoperative Ki-67 with a HR of 3.61 (P = 0.003), neutrophil-to-lymphocyte ratio with an HR of 2.20 (P = 0.0005), and glomerular filtration rate with an HR of 3.35 (P = 0.0009). Tumor-specific predictors identified were tumor stage with an HR of 4.67 (P < 0.00001), lymphovascular invasion with an HR of 2.37 (P = 0.004), and lymph node status with an HR of 2.68 (P < 0.0001). Regarding treatment-specific predictors, positive surgical margins were associated with an HR of 3.97 (P = 0.0005), and adjuvant chemotherapy was associated with an HR of 1.65 (P = 0.03).
Our study identified three significant predictors across patient, tumor, and treatment dimensions for extravesical recurrence following radical nephroureterectomy in patients with upper urinary tract uroepithelial carcinoma. We hypothesize that history of bladder cancer, platelet-to-lymphocyte ratio, and urinary cytology could also be strong predictors of post- RNU extravesical recurrence in patients with upper UTUC, assuming adequate sample size and controlled heterogeneity. This research aims to provide urological clinicians with enhanced guidance for postoperative decision-making.
众多研究已对根治性肾切除术（RNU）后上尿路尿路上皮癌（UTUC）患者膀胱内复发的预测因素进行了调查。相比之下，膀胱外复发（EUR）受到的关注较少。因此，本研究旨在通过系统的文献综述和荟萃分析来评估RNU后EUR的显著预测因素。
我们在PubMed、Embase和Cochrane数据库中进行了计算机化文献检索，以识别包含EUR预测因素多变量分析详细结果的报告。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南和AMSTAR（评估系统评价的方法学质量）标准，我们选择了13项回顾性研究，每项研究的样本量均超过100例。使用Review Manager 5.4软件，我们对可用风险比（HR）及其相应的95%置信区间进行了累积分析，以评估EUR的潜在预测因素。
我们的研究结果表明，患者特异性预测因素包括术前Ki-67，HR为3.61（P = 0.003）；中性粒细胞与淋巴细胞比值，HR为2.20（P = 0.0005）；肾小球滤过率，HR为3.35（P = 0.0009）。确定的肿瘤特异性预测因素为肿瘤分期，HR为4.67（P < 0.00001）；淋巴管侵犯，HR为2.37（P = 0.004）；淋巴结状态，HR为2.68（P < 0.0001）。关于治疗特异性预测因素，手术切缘阳性与HR为3.97相关（P = 0.0005），辅助化疗与HR为1.65相关（P = 0.03）。
我们的研究确定了上尿路尿路上皮癌患者根治性肾输尿管切除术后膀胱外复发在患者、肿瘤和治疗维度上的三个显著预测因素。我们假设，膀胱癌病史、血小板与淋巴细胞比值和尿细胞学检查也可能是上尿路UTUC患者RNU后膀胱外复发的强预测因素，前提是样本量充足且异质性得到控制。本研究旨在为泌尿外科临床医生提供更强的术后决策指导。
