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Review
. 2022 Jun 28:42:19-29.
doi: 10.1016/j.euros.2022.06.001. eCollection 2022 Aug.

Prognostic Value of Tumor Size in Patients with Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis

Runzhuo Ma  1   2 , Zenan Liu  1 , Yinchu Cheng  3 , Pengxiang Zhou  3 , Yuting Pan  4 , Hai Bi  1 , Liyuan Tao  5 , Bin Yang  1 , Haizhui Xia  1 , Xuehua Zhu  1 , Jide He  1 , Wei He  1 , Guoliang Wang  1 , Yi Huang  1 , Lulin Ma  1 , Jian Lu  1
Affiliations
Review

Prognostic Value of Tumor Size in Patients with Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis

Runzhuo Ma et al. Eur Urol Open Sci. .

Abstract

Context: The role of tumor size in predicting prognosis in upper tract urothelial carcinoma (UTUC) patients remains poorly defined.

Objective: To assess the prognostic value of tumor size in patients with UTUC through a systematic review and meta-analysis.

Evidence acquisition: 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.

Evidence synthesis: 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 p < 0.10 and I2 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.

Conclusions: 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.

Patient summary: 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.

Keywords: Meta-analysis; Prognosis; Tumor size; Upper tract urothelial carcinoma.

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Figures

Fig. 1
Fig. 1
A flowchart of the study selection process. UTUC = upper tract urothelial carcinoma.
Fig. 2
Fig. 2
Forest plots showing the association between tumor size and survival outcomes in UTUC patients: (A) overall survival, (B) cancer-specific survival, (C) recurrence-free survival, and (D) intravesical recurrence. CI = confidence interval; df = degree of freedom; IV = inverse variance; SE = standard error; UTUC = upper tract urothelial carcinoma.
Fig. 2
Fig. 2
Forest plots showing the association between tumor size and survival outcomes in UTUC patients: (A) overall survival, (B) cancer-specific survival, (C) recurrence-free survival, and (D) intravesical recurrence. CI = confidence interval; df = degree of freedom; IV = inverse variance; SE = standard error; UTUC = upper tract urothelial carcinoma.
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References

    1. Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7–30. - PubMed
    1. Rouprêt M., Babjuk M., Burger M., et al. European Association of Urology guidelines on upper urinary tract urothelial carcinoma: 2020 update. Eur Urol. 2021;79:62–79. - PubMed
    1. Margulis V., Shariat S.F., Matin S.F., et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009;115:1224–1233. - PubMed
    1. Ploussard G., Xylinas E., Lotan Y., et al. Conditional survival after radical nephroureterectomy for upper tract carcinoma. Eur Urol. 2015;67:803–812. - PubMed
    1. Cha E.K., Shariat S.F., Kormaksson M., et al. Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2012;61:818–825. - PubMed

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