Abstract
Background. Epidemiological studies have reported various results relating preoperative hydronephrosis to upper tract urothelial carcinoma (UTUC). However, the clinical significance and prognostic value of preoperative hydronephrosis in UTUC remains controversial. The aim of this study was to provide a comprehensive meta-analysis of the extent of the possible association between preoperative hydronephrosis and the risk of UTUC.Methods. We searched PubMed, ISI Web of Knowledge, and Embase to identify eligible studies written in English. Summary odds ratios (ORs) or hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using fixed-effects or random-effects models. Results. Nineteen relevant studies, which had a total of 5,782 UTUC patients enrolled, were selected for statistical analysis. The clinicopathological and prognostic relevance of preoperative hydronephrosis was evaluated in the UTUC patients. The results showed that all tumor stages, lymph node status and tumor location, as well as the risk of cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were significantly different between UTUC patients with elevated preoperative hydronephrosis and those with low preoperative hydronephrosis. High preoperative hydronephrosis indicated a poor prognosis. Additionally, significant correlations between preoperative hydronephrosis and tumor grade (high grade vs. low grade) were observed in UTUC patients; however, no significant difference was observed for tumor grading (G1 vs. G2 + G3 and G1 + G2 vs. G3). In contrast, no such correlations were evident for recurrence status or gender in UTUC patients.Conclusions. The results of this meta-analysis suggest that preoperative hydronephrosis is associated with increased risk and poor survival in UTUC patients. The presence of preoperative hydronephrosis plays an important role in the carcinogenesis and prognosis of UTUC.
Highlights
Upper tract urothelial carcinoma (UTUC), including tumors of the urothelium of the renal pelvis and the ureter, accounts for approximately 5–10% of urinary tract carcinomas (Roupret et al, 2015; Siegel, Naishadham & Jemal, 2012)
Fourteen articles assessed the prognostic value of preoperative hydronephrosis (CSS/overall survival (OS)/recurrence-free survival (RFS)/metastasis-free survival (MFS)) of upper tract urothelial carcinoma (UTUC) patients using the Kaplan–Meier method (Bozzini et al, 2013; Chapman et al, 2009; Chung et al, 2014; Colin et al, 2014; Hwang et al, 2013; Liang et al, 2016; Luo et al, 2013; Ng et al, 2011; Sakano et al, 2013; Xing et al, 2016; Yeh et al, 2015; Zhang et al, 2016; Zhang et al, 2013; Zhang et al, 2015)
A total of 5,782 patients were included in this meta-analysis, and they were from 7 countries (Korea, USA, Japan, France, China, Canada, Taiwan)
Summary
Upper tract urothelial carcinoma (UTUC), including tumors of the urothelium of the renal pelvis and the ureter, accounts for approximately 5–10% of urinary tract carcinomas (Roupret et al, 2015; Siegel, Naishadham & Jemal, 2012). Ito et al (2011) confirmed that preoperative hydronephrosis is an independent predictor of poor tumor pathological outcomes in a study of patients with UTUC after nephroureterectomy. The results showed that all tumor stages, lymph node status and tumor location, as well as the risk of cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were significantly different between UTUC patients with elevated preoperative hydronephrosis and those with low preoperative hydronephrosis. Significant correlations between preoperative hydronephrosis and tumor grade (high grade vs low grade) were observed in UTUC patients; no significant difference was observed for tumor grading (G1 vs G2 + G3 and G1 + G2 vs G3). The results of this meta-analysis suggest that preoperative hydronephrosis is associated with increased risk and poor survival in UTUC patients. The presence of preoperative hydronephrosis plays an important role in the carcinogenesis and prognosis of UTUC
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