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Meta-Analysis
. 2018 Apr 10;18(1):24.
doi: 10.1186/s12894-018-0336-5.

Role of lymph node dissection in the management of upper tract urothelial carcinomas: a meta-analysis

Runqi Guo  1 , Yuze Zhu  1 , Gengyan Xiong  1 , Xuesong Li  1 , Kai Zhang  2 , Liqun Zhou  3
Affiliations
Meta-Analysis

Role of lymph node dissection in the management of upper tract urothelial carcinomas: a meta-analysis

Runqi Guo et al. BMC Urol. .

Abstract

Background: Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in upper tract urothelial carcinomas (UTUC) and the role of LND has been controversial. We aim to investigate whether patients with LND had improved survival in UTUC patients.

Methods: We performed a systematic literature search of PubMed, Embase, and Cochrane library for citations published prior to January 2016, describing LND performed among UTUC patients and conducted a standard meta-analysis of survival outcomes.

Results: Eleven eligible studies containing 7516 patients satisfied the inclusion criteria. Pooled HRs for cancer-specific survival (CSS) and recurrence-free survival (RFS) were 1.17 (P = 0.18) and 1.33 (P = 0.19) respectively. However, the patients in the LND group had more advanced tumour stages and grades (P < 0.001). Further subgroup analysis showed that among muscle-invasive UTUC patients, the pooled HR for CSS and RFS were 1.10 (P = 0.42) and 0.92 (P = 0.72) respectively. Besides, no difference was found in CSS and RFS between pN0 and pNx individuals in overall populations and in patients with muscle-invasive UTUC, while pN+ patients had significantly worse prognosis when compared to pN0 patients.

Conclusions: LND during RNU allows more accurate staging and prediction of survival, but it remains uncertain whether LND independently improves survival in patients with UTUC. However, standard use of LND should be further investigated in a multi-center, prospective evaluation to obtain a definitive statement regarding this matter.

Keywords: Lymph node dissection; Recurrence; Survival; Upper urinary tract; Urothelial carcinoma.

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Conflict of interest statement

Competing interest

The authors declare that they have no competing interests.

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Not applicable.

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Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Forest plot comparing survival and subgroup analysis of different pT statuses. (A1) CSS in patients receiving LND versus NLND; (A2) CSS in patients considered pN0/pNx; (A3) CSS in patients considered pN+/pN0; (B1) RFS in patients receiving LND versus NLND; (B2) RFS in patients considered pN0/pNx; (B3) RFS in patients considered pN+/pN0; (C1) CSS in muscle-invasive UTUC patients receiving LND versus NLND; (C2) RFS in muscle-invasive UTUC patients receiving LND versus NLND; (C3) CSS in patients of muscle-invasive UTUC considered pN0/pNx; (C4) RFS survival in patients of muscle-invasive UTUC considered pN0/pNx; (C5) CSS in patients of muscle-invasive UTUC considered pN+/pN0; (C6) RFS survival in patients of muscle-invasive UTUC considered pN+/pN0. CSS, cancer-specific surviva; LND: lymph node dissection; NLND: non-lymph node dissection; pN0: Negative lymph node; pNx: Not undergo lymph node dissection; RFS, recurrence-free survival; UTUC: upper tract urothelial carcinoma.
Fig. 3
Fig. 3
Funnel plot for the evaluation of potential publication bias. (a) cancer-specific survival; (b) recurrence-free survival
See this image and copyright information in PMC

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