伴原位癌的上尿路尿路上皮癌患者行根治性肾输尿管切除术的预后荟萃分析

目的系统性评价伴原位癌对上尿路尿路上皮癌患者根治性肾输尿管切除术后肿瘤学预后的影响。方法根据PRISMA原则由2名独立研究员检索PubMed、EMBASE、Web of Science、中国数字图书馆、万方数据库中有关伴原位癌与根治性肾输尿管切除术后患者肿瘤生存结局方面的研究,并且手工检索与之相关的所有参考文献。检索时间为建库至2019年6月,检索语种为英文和中文。英文检索词为upper urinary tract tumor、renal pelvis、radical nephroureterectomy、concomitant carcinoma in situ、prognosis、survival,中文检索词为上尿路尿路上皮癌、肾盂癌、伴原位癌、根治性肾输尿管切除术。采用QUIPS文献质量评价工具对纳入的文献进行方法质量学评价,并使用Stata 12.0和RevMan 5.3软件进行相关数据的统计分析。结果共纳入16篇相关文献,发表时间2012—2019年。上尿路尿路上皮癌患者共11131例,其中伴原位癌患者1774例,阳性率为15.9%。伴原位癌患者根治性肾输尿管切除术后的肿瘤特异性生存率[HR=1.10,95%CI 1.05~1.16,P<0.001]、无复发生存率[HR=1.15,95%CI 1.09~1.21,P<0.001]和总体生存率[HR=1.10,95%CI 1.03~1.17,P=0.003]均低于不伴原位癌患者。Begg's发表偏倚分析显示在肿瘤特异性生存率(P=0.822)、无复发生存率(P=0.348)、总体生存率(P=0.452)方面均无显著的发表偏倚。结论伴原位癌的上尿路尿路上皮癌患者根治性肾输尿管切除术后的临床预后较差。伴原位癌可作为此类患者术后生存结局的独立影响因子。

The prognostic value of concomitant carcinoma in situ in patients with upper tract urinary carcinoma after radical nephroureterectomy:an systematic review and Meta-analysis

Objective The aim of this study was to evaluate the influence of concomitant carcinoma in situ(CCIS)on tumor survival for the upper tract urinary carcinoma(UTUC)through systematic review and meta-analysis.Methods In the light of Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)guidelines,a systematic search of Web of Science,PubMed and EMBASE China National Knowledge Infrastructure(CNKI)and Wanfang database by key words"upper urinary tract urothelial carcinoma""renal sputum cancer""concomitant carcinoma in situ",and"radical ureterectomy"were performed for all reports that included detailed results on the predictors of CCIS.The search deadline is June 2019,and the search terms are English and Chinese.Methodological quality evaluation was performed using the QUIPS tool,and statistical analysis of the relevant data was performed using Stata 12.0 and RevMan 5.3 software.Results Sixteen articles were included in this study and all published between 2012 and 2019.A total of 11131 patients with UTUC,including 1774(15.9%)patients with CCIS.According to our final results,there was a significant correlation of CCIS with worse cancer-specific survival(CSS)(HR=1.10,95%CI 1.05-1.16,P<0.001),recurrence-free survival(RFS)(HR=1.15,95%CI 1.09-1.21,P<0.001)and overall survival(OS)(HR=1.10,95%CI 1.03-1.17,P=0.003).Begg′s bias analysis showed no significant publication bias in CSS(P=0.822),RFS(P=0.348),and OS(P=0.452).Conclusions This study demonstrated that CCIS was associated with poor oncological outcome and could serve as a independent prognostic factor for patient with UTUC after radical nephroureterectomy.