中国循证医学杂志

中国循证医学杂志

上尿路尿路上皮癌患者根治性肾输尿管切除术后膀胱内复发危险因素的 Meta 分析

查看全文

目的系统评价上尿路尿路上皮癌(UTUC)患者根治性肾输尿管切除(RNU)术后膀胱内复发(IVR)的危险因素。方法计算机检索 PubMed、EMbase、The Cochrane Library、CBM、CNKI、VIP 和 WanFang Data 数据库,搜集有关 UTUC 患者 RNU 术后 IVR 危险因素的病例-对照研究,检索时限均为建库至 2017 年 8 月。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 23 个研究,包括 8 614 例患者。Meta 分析结果显示:既往膀胱癌病史[HR=1.77,95%CI(1.42,2.22),P<0.001]、肿瘤分期(≥T2)[HR=1.41,95%CI(1.09,1.82),P=0.009]、输尿管肿瘤[HR=1.34,95%CI(1.20,1.49),P<0.000 01]、多发性肿瘤[HR=1.51,95%CI(1.34,1.69),P<0.001]、淋巴血管浸润[HR=1.43,95%CI(1.20,1.70),P<0.000 1]、腹腔镜手术[HR=1.52,95%CI(1.08,2.15),P=0.02]、肿瘤切缘阳性[HR=1.87,95%CI(1.17,2.99),P=0.009]和术前输尿管镜检查[HR=1.46,95%CI(1.21,1.75),P<0.001]均是 UTUC 患者 RNU 术后 IVR 的危险因素。结论当前证据表明,既往膀胱癌病史、肿瘤分期(≥T2)、输尿管肿瘤等是 UTUC 患者 RNU 术后 IVR 的危险因素。受纳入研究质量限制,上述结论尚待更多高质量研究予以验证。

ObjectiveTo systematically review the risk factors for intravesical recurrence (IVR) after radical nephroureterectomy (RNU) of upper tract urothelial carcinoma (UTUC).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies about the risk factors for IVR after RNU of UTUC from inception to August 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 studies involving 8 614 patients were included. The results of meta-analysis showed that the history of bladder cancer (HR=1.77, 95%CI 1.42 to 2.22, P<0.001), tumor stage (≥T2) (HR=1.41, 95%CI 1.09 to 1.82,P=0.009), ureteral tumor (HR=1.34, 95%CI 1.20 to 1.49, P<0.000 01), tumor multifocality (HR=1.51, 95%CI 1.34 to 1.69,P<0.001), lymphovascular invasion (HR=1.43, 95%CI 1.20 to 1.70,P<0.000 1), laparoscopic surgery (HR=1.52, 95%CI 1.08 to 2.15,P=0.02), positive surgical margins (HR=1.87, 95%CI 1.17 to 2.99, P=0.009), and preoperative ureteroscopy (HR=1.46, 95%CI 1.21 to 1.75, P<0.001) were the risk factors for IVR after RNU.ConclusionsCurrent evidence shows that the risk factors for IVR after RNU include history bladder cancer, tumor stage (≥T2), ureteral tumor, etc. Due to the limited quality of the included studies, more high quality studies are required to verify the above conclusion.

关键词: 上尿路; 尿路上皮癌; 根治性肾输尿管切除术; 膀胱内复发; 危险因素; Meta 分析; 系统评价; 病例-对照研究

Key words: Upper urinary tract; Urothelial carcinoma; Radical nephroureterectomy; Intravesical recurrence; Risk factor; Meta-analysis; Systematic review; Case-control study

引用本文: 郑铎, 尚攀峰, 刘隽垚, 李冬梅, 齐鹏, 刘腾飞, 岳中瑾, 吴恭瑾. 上尿路尿路上皮癌患者根治性肾输尿管切除术后膀胱内复发危险因素的 Meta 分析. 中国循证医学杂志, 2018, 18(3): 305-313. doi: 10.7507/1672-2531.201710121 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Seisen T, Granger B, Colin P, et al. A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma. Eur Urol, 2015, 193(4): 1122-1133.
2. 周利群, 李学松, 方冬. 上尿路尿路上皮癌治疗方式的选择. 临床泌尿外科杂志, 2016, 31(11): 961-964.
3. 郑铎, 刘隽壵, 齐鹏, 等. 上尿路尿路上皮癌术后膀胱内复发危险因素的研究进展. 中华泌尿外科杂志, 2017, 38(5): 395-397.
4. Wells GA, Shea BJ, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2012, 18(6): 727-734.
5. Chung SD, Huang KH, Lai MK, et al. CKD as a risk factor for bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Am J Kidney Dis, 2007, 50(5): 743-753.
6. Favaretto RL, Shariat SF, Chade DC, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol, 2010, 58(5): 645-651.
7. Ku JH, Choi WS, Kwak C, et al. Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract. Urol Oncol, 2011, 29(4): 383-387.
8. Hirano D, Okada Y, Nagane Y, et al. Intravesical recurrence after surgical management of urothelial carcinoma of the upper urinary tract. Urol Int, 2012, 89(1): 71-77.
9. Kobayashi Y, Saika T, Miyaji Y, et al. Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma. World J Urol, 2012, 30(2): 271-275.
10. Elalouf V, Xylinas E, Klap J, et al. Bladder recurrence after radical nephroureterectomy: predictors and impact on oncological outcomes. Int J Urol, 2013, 20(11): 1078-1083.
11. Ishioka J, Saito K, Kijima T, et al. Risk stratification for bladder recurrence of upper urinary tract urothelial carcinoma after radical nephroureterectomy. BJU Int, 2015, 115(5): 705-712.
12. Kim KH, You D, Jeong IG, et al. Muscle-invasive bladder cancer developing after nephroureterectomy for upper urinary tract urothelial carcinoma. Urol Oncol, 2013, 31(8): 1643-1649.
13. Luo LH, Kang CH, Chen YT, et al. Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Ann Surg Oncol, 2013, 20(9): 3121.
14. Xylinas E, Colin P, Audenet F, et al. Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study. World J Urol, 2013, 31(1): 61-68.
15. Fang D, Xiong GY, Li XS, et al. Pattern and risk factors of intravesical recurrence after nephroureterectomy for upper tract urothelial carcinoma: a large Chinese center experience. J Formos Med Assoc, 2014, 113(11): 820-827.
16. Fradet V, Mauermann J, Kassouf W, et al. Risk factors for bladder cancer recurrence after nephroureterectomy for upper tract urothelial tumors: results from the Canadian Upper Tract Collaboration. Urol Oncol, 2014, 32(6): 839-845.
17. Liu Y, Lu J, Hong K, et al. Independent prognostic factors for initial intravesical recurrence after laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma. Urol Oncol, 2014, 32(2): 146-152.
18. Tanaka N, Kikuchi E, Kanao K, et al. The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study. Urol Oncol, 2014, 32(1): 48.
19. Xylinas E, Kluth LA, Rieken M, et al. Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy. BJU Int, 2014, 114(1): 56-61.
20. Hu CY, Tsai YC, Wang SM, et al. Ureteral involvement and diabetes increase the risk of subsequent bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Biomed Res Int, 2015, 2015: 527976.
21. Kimura S, Miki J, Tsuduki S, et al. Risk factors for intravesical recurrence after surgical management of urotherial carcinoma of the upper urinary tract. Nihon Hinyokika Gakkai Zasshi, 2015, 106(4): 231-237.
22. Narukawa T, Hara T, Arai E, et al. Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer. Jpn J Clin Oncol, 2015, 45(5): 488-493.
23. Sung HH, Jeon HG, Han DH, et al. Diagnostic ureterorenoscopy is associated with increased intravesical recurrence following radical nephroureterectomy in upper tract urothelial carcinoma. PLoS One, 2015, 10(11): e0139976.
24. Otsuka M, Taguchi S, Nakagawa T, et al. Lower ureteral lesion is an independent predictor of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. Urol Oncol, 2016, 34(2): 59.
25. 邢云超, 熊耕砚, 方东, 等. 上尿路尿路上皮癌术前预后相关因素分析及初步风险分层模型构建. 北京大学学报(医学版), 2016, 48(6): 1032-1037.
26. Shigeta K, Kikuchi E, Hagiwara M, et al. Prolonged pneumoperitoneum time is an independent risk factor for intravesical recurrence after laparoscopic radical nephroureterectomy in upper tract urothelial carcinoma. Surg Oncol, 2017, 26(1): 73-79.
27. Yoo S, You D, Song C, et al. Risk of intravesical recurrence after ureteroscopic biopsy for upper tract urothelial carcinoma: does the location matter? J Endourol, 2017, 31(3): 259-265.
28. 周利群, 李学松, 熊耕砚. 中国人群上尿路尿路上皮癌新进展. 北京大学学报(医学版), 2014, 46(4): 504-506.
29. Hafner C, Knuechel R, Zanardo L, et al. Evidence for oligoclonality and tumor spread by intraluminal seeding in multifocal urothelial carcinomas of the upper and lower urinary tract. Oncogene, 2001, 20(35): 4910-4915.
30. Catto JW, Hartmann A, Stoehr R, et al. Multifocal urothelial cancers with the mutator phenotype are of monoclonal origin and require panurothelial treatment for tumor clearance. J Urol, 2006, 175(6): 2323-2330.
31. Hall MC, Womack S, Sagalowsky AI, et al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology, 1998, 52(4): 594-601.
32. Muntener M, Schaeffer EM, Romero FR, et al. Incidence of local recurrence and port site metastasis after laparoscopic radical nephroureterectomy. Urology, 2007, 70(5): 864-868.
33. Goble NM, Clarke T, Hammonds JC. Histological changes in the urinary bladder secondary to urethral catheterisation. Br J Urol, 1989, 63(4): 354-357.
34. See WA, Chapman WH. Tumor cell implantation following neodymium-YAG bladder injury: a comparison to electrocautery injury. J Urol, 1987, 137(6): 1266-1269.
35. See WA, Miller JS, Williams RD. Pathophysiology of transitional tumor cell adherence to sites of urothelial injury in rats: mechanisms mediating intravesical recurrence due to implantation. Cancer Res, 1989, 49(19): 5414-5418.
36. Xylinas E, Rink M, Cha EK, et al. Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol, 2014, 65(1): 210-217.
37. 王超, 姜行康, 李慧, 等. 上尿路尿路上皮癌根治术后膀胱肿瘤复发的危险因素分析. 山东医药, 2015, 55(18): 18-20.
38. Rouprêt M, Babjuk M, Compérat E, et al. European Association of Urology Guidelines on upper urinary tract urothelial carcinoma: 2017 update. Eur Urol, 2018, 73(1): 111-122.
39. Hafner C, Knuechel R, Stoehr R, et al. Clonality of multifocal urothelial carcinomas: 10 years of molecular genetic studies. Int J Cancer, 2002, 101(1): 1-6.