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Meta-Analysis
. 2024 May 14;42(1):318.
doi: 10.1007/s00345-024-05032-y.

Endoscopic intervention versus radical nephroureterectomy for the management of localized upper urinary tract urothelial carcinoma: a systematic review and meta-analysis of comparative studies

Carlo Giulioni  1 , Carlo Brocca  2 , Pietro Tramanzoli  2 , Silvia Stramucci  2 , Matteo Mantovan  2 , Leonard Perpepaj  2 , Andrea Cicconofri  2 , Vineet Gauhar  3 , Axel Stuart Merseburger  4 , Andrea Benedetto Galosi  2 , Daniele Castellani  2
Affiliations
Meta-Analysis

Endoscopic intervention versus radical nephroureterectomy for the management of localized upper urinary tract urothelial carcinoma: a systematic review and meta-analysis of comparative studies

Carlo Giulioni et al. World J Urol. .

Abstract

Objective: Localized Upper Urinary Tract Urothelial Carcinoma (UTUC) is an uncommon cancer typically detected at an advanced stage. Currently, radical nephroureterectomy (RNU) with bladder cuff excision is the standard treatment for high-risk UTUC. This meta-analysis aims to evaluate the 5-year overall and cancer-specific survival and bladder recurrence rates in studies comparing endoscopic kidney-sparing surgeries (E-KSS) with RNU in localized UTUC.

Evidence acquisition: We performed a literature search on 20th April 2023 through PubMed, Web of Science, and Scopus. The PICOS model was used for study inclusion: P: adult patients with localized UTUC; I: E-KSS. C: RNU; O: primary: overall survival (OS); secondary: cancer-specific survival (CSS), bladder recurrence rate, and metastasis-free survival (MFS). S: retrospective, prospective, and randomized studies.

Evidence synthesis: Overall, 11 studies involving 2284 patients were eligible for this meta-analysis, 737 in the E-KSS group and 1547 in the RNU group. E-KSS showed a similar overall 5-year OS between E-KSS and RNU, and for low-grade tumors, while 5-year OS favored RNU for high-grade tumors (RR 1.84, 95% CI 1.26-2.69, p = 0.002). No difference emerged for 5-year CSS between the two groups, even when the results were stratified for low- and high grade tumors. Bladder recurrence rate and 5-year MFS were also similar between the two groups.

Conclusions: Our review showed that E-KSS is a viable option for patients with localized UTUC with non-inferior oncological outcomes as compared with RNU, except for 5-year OS in high-grade tumors which favoured RNU.

Keywords: Endoscopic treatment; Localized upper urinary tract urothelial carcinoma; Nephron-sparing surgery; Radical nephroureterectomy; Survival.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Forrest plots of 5-year Overall Survival of studies comparing Endoscopic kidney-sparing surgery (E-KSS) versus Radical nephroureterectomy (RNU). Analysis of: overall tumors (a); low-grade tumors (b); high-grade tumors (c)
Fig. 2
Fig. 2
Forrest plots of 5-year cancer specific Survival of studies comparing Endoscopic kidney-sparing surgery (E-KSS) versus Radical nephroureterectomy (RNU). Analysis of: overall tumors (a); low-grade tumors (b); high-grade tumors (c)
Fig. 3
Fig. 3
Forrest plot of the Bladder recurrence rate (a) and 5-year Metastasis-free Survival (b) of studies comparing Endoscopic kidney-sparing surgery (E-KSS) and Radical nephroureterectomy (RNU)
See this image and copyright information in PMC

Comment in

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