A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

doi:10.3389/fsurg.2022.879774

Review

. 2022 Oct 4:9:879774.

doi: 10.3389/fsurg.2022.879774. eCollection 2022.

A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

Jeffrey J Leow^{1

2}, Wei Shen Tan^{3

4}, Wei Phin Tan⁵, Teck Wei Tan^{1

2}, Vinson Wai-Shun Chan^{6

7

8}, Kari A O Tikkinen^{9

10}, Ashish Kamat¹¹, Shomik Sengupta^{12

13}, Maxwell V Meng¹⁴, Shahrokh Shariat^{15

16

17

18

19}, Morgan Roupret²⁰, Karel Decaestecker^{21

22

23}, Nikhil Vasdev²⁴, Yew Lam Chong^{1

2}, Dmitry Enikeev^{15

25}, Gianluca Giannarini²⁶, Vincenzo Ficarra²⁷, Jeremy Yuen-Chun Teoh^{28

29}; UroSoMe Collaborators

Affiliations

¹ Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore.
² Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
³ Division of Surgery and Interventional Science, University College London, London, United Kingdom.
⁴ Department of Urology, University College London Hospital, London, United Kingdom.
⁵ Department of Urology, NYU Langone Health, New York City, NY, United States.
⁶ Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom.
⁷ Leeds Institute of Medical Research, University of Leeds, Leeds, United Kindgom.
⁸ Division of Surgery and Interventional Sciences, University College London, United Kingdom.
⁹ Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁰ Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland.
¹¹ Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
¹² Urology Department, Eastern Health, Box Hill, Victoria, Australia.
¹³ Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.
¹⁴ Department of Urology, University of California San Francisco, San Francisco, CA, United States.
¹⁵ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁶ Department of Urology, Weill Cornell Medical College, New York, New York, USA.
¹⁷ Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.
¹⁸ Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.
¹⁹ Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
²⁰ Sorbonne University, GRC N 5, Predicitive Onco-uro, AP-HP, Hôpital Pitié-Salpêtriére, Paris, France.
²¹ Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium.
²² Department of Urology, Ghent University Hospital, Ghent, Belgium.
²³ Department of Human Structure and Repair, Ghent University, Belgium.
²⁴ Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital Stevenage, School of Medicine and Life Sciences, University of Hertfordshire, Hatfield, United Kingdom.
²⁵ Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
²⁶ Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy.
²⁷ Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy.
²⁸ S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
²⁹ European Association of Urology - Young Academic Urologists Urothelial Carcinoma Working Group (EAU-YAU), Arnhem, Netherlands.

PMID: 36268209
PMCID: PMC9577485
DOI: 10.3389/fsurg.2022.879774

Review

A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

Jeffrey J Leow et al. Front Surg. 2022.

. 2022 Oct 4:9:879774.

doi: 10.3389/fsurg.2022.879774. eCollection 2022.

Authors

Affiliations

¹ Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore.
² Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
³ Division of Surgery and Interventional Science, University College London, London, United Kingdom.
⁴ Department of Urology, University College London Hospital, London, United Kingdom.
⁵ Department of Urology, NYU Langone Health, New York City, NY, United States.
⁶ Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom.
⁷ Leeds Institute of Medical Research, University of Leeds, Leeds, United Kindgom.
⁸ Division of Surgery and Interventional Sciences, University College London, United Kingdom.
⁹ Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁰ Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland.
¹¹ Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
¹² Urology Department, Eastern Health, Box Hill, Victoria, Australia.
¹³ Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.
¹⁴ Department of Urology, University of California San Francisco, San Francisco, CA, United States.
¹⁵ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁶ Department of Urology, Weill Cornell Medical College, New York, New York, USA.
¹⁷ Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.
¹⁸ Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.
¹⁹ Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
²⁰ Sorbonne University, GRC N 5, Predicitive Onco-uro, AP-HP, Hôpital Pitié-Salpêtriére, Paris, France.
²¹ Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium.
²² Department of Urology, Ghent University Hospital, Ghent, Belgium.
²³ Department of Human Structure and Repair, Ghent University, Belgium.
²⁴ Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital Stevenage, School of Medicine and Life Sciences, University of Hertfordshire, Hatfield, United Kingdom.
²⁵ Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
²⁶ Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy.
²⁷ Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy.
²⁸ S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
²⁹ European Association of Urology - Young Academic Urologists Urothelial Carcinoma Working Group (EAU-YAU), Arnhem, Netherlands.

PMID: 36268209
PMCID: PMC9577485
DOI: 10.3389/fsurg.2022.879774

Abstract

Purpose: The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC.

Methods: We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed.

Results: We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09-1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96-1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19-2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50-4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery.

Conclusions: A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.

Keywords: bladder cancer; bladder carcinoma; delay in surgery; delayed treatment; time-to-treatment; ureteral neoplasms; urinary bladder neoplasms; urothelial carcinoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 2**
Forrest plot for meta-analysis on effect of delayed radical cystectomy on overall survival in bladder cancer.

**Figure 3**
Forrest plot for meta-analysis on effect of delayed radical nephro-ureterectomy on overall survival in upper tract urothelial carcinoma.

**Figure 4**
Forrest plot for meta-analysis on effect of delayed radical nephro-ureterectomy on cancer-specific survival in upper tract urothelial carcinoma.

See this image and copyright information in PMC

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References

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1. Tan WS, Feber A, Sarpong R, Khetrapal P, Rodney S, Jalil R, et al. Who should be investigated for haematuria? Results of a contemporary prospective observational study of 3556 patients. Eur Urol. (2018) 74(1):10–4. 10.1016/j.eururo.2018.03.008 - DOI - PubMed
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[1] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. (2018) 68(6):394–424. 10.3322/caac.21492 - DOI - PubMed

[2] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. (2018) 68(6):394–424. 10.3322/caac.21492 - DOI - PubMed

[3] Teoh JY, Huang J, Ko WY, Lok V, Choi P, Ng CF, et al. Global trends of bladder cancer incidence and mortality, and their associations with tobacco use and gross domestic product per capita. Eur Urol. (2020) 78(6):893–906. 10.1016/j.eururo.2020.09.006 - DOI - PubMed

[4] Teoh JY, Huang J, Ko WY, Lok V, Choi P, Ng CF, et al. Global trends of bladder cancer incidence and mortality, and their associations with tobacco use and gross domestic product per capita. Eur Urol. (2020) 78(6):893–906. 10.1016/j.eururo.2020.09.006 - DOI - PubMed

[5] Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol. (2017) 71(1):96–108. 10.1016/j.eururo.2016.06.010 - DOI - PubMed

[6] Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol. (2017) 71(1):96–108. 10.1016/j.eururo.2016.06.010 - DOI - PubMed

[7] Tan WS, Feber A, Sarpong R, Khetrapal P, Rodney S, Jalil R, et al. Who should be investigated for haematuria? Results of a contemporary prospective observational study of 3556 patients. Eur Urol. (2018) 74(1):10–4. 10.1016/j.eururo.2018.03.008 - DOI - PubMed

[8] Tan WS, Feber A, Sarpong R, Khetrapal P, Rodney S, Jalil R, et al. Who should be investigated for haematuria? Results of a contemporary prospective observational study of 3556 patients. Eur Urol. (2018) 74(1):10–4. 10.1016/j.eururo.2018.03.008 - DOI - PubMed

[9] David KA, Mallin K, Milowsky MI, Ritchey J, Carroll PR, Nanus DM. Surveillance of urothelial carcinoma: stage and grade migration, 1993-2005 and survival trends, 1993-2000. Cancer. (2009) 115(7):1435–47. 10.1002/cncr.24147 - DOI - PubMed

[10] David KA, Mallin K, Milowsky MI, Ritchey J, Carroll PR, Nanus DM. Surveillance of urothelial carcinoma: stage and grade migration, 1993-2005 and survival trends, 1993-2000. Cancer. (2009) 115(7):1435–47. 10.1002/cncr.24147 - DOI - PubMed

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A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

Affiliations

A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

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