Abstract
This study was performed to identify the prognostic impact of lymphovascular invasion (LVI) in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). A systematic search in PubMed, Embase, and the Cochrane Library was performed to identify relevant studies. The outcomes of interest, including progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS), were extracted, and the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used for effect size estimation. Subgroup, metaregression, and sensitivity analyses were performed to explore potential origins of heterogeneity. Publication bias was estimated by Egger's linear regression and funnel plot. Our meta-analysis included a total of 27 studies involving 17,453 patients. The pooled HRs were statistically significant for PFS (HR = 1.73, 95%CI = 1.41–2.11), CSS (HR = 1.87, 95%CI = 1.54–2.27), and OS (HR = 1.56, 95%CI = 1.29–1.87), with high heterogeneity (I2 = 77.8%, 70.3%, and 59.2%, respectively). Four studies explored the prognostic value of LVI in patients with advanced tumor stages (T3–T4). The fixed effects model (I2 = 33.9%) showed that the pooled HR was 1.64 (95%CI = 1.35–1.99) for CSS. Egger's plots showed no significant publication bias (PFS: P = 0.443, CSS: P = 0.096, and OS: P = 0.894). Our meta-analysis demonstrated that LVI is a poor prognostic factor for UTUC and is strongly associated with disease recurrence, cancer-specific mortality, and overall mortality.
Highlights
Upper urinary tract urothelial carcinoma (UTUC) accounts for 10% of renal tumors and 5% of all urothelial malignancies [1, 2]
Studies were included if they met the following criteria: (1) the study evaluated lymphovascular invasion (LVI) as a prognostic factor in patients with UTUC after Radical nephroureterectomy (RNU); (2) the study reported adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of progression-free survival (PFS), cancer-specific survival (CSS), or overall survival (OS) in a multivariate analysis with Cox proportional hazard regression; and (3) the study was published in English
27 articles were included in this study to explore the prognostic value of LVI in UTUC [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36], among which 4 articles analyzed LVI as a survival predictor in patients with advanced tumor stages (T3–T4) [10, 13, 16, 26]
Summary
Upper urinary tract urothelial carcinoma (UTUC) accounts for 10% of renal tumors and 5% of all urothelial malignancies [1, 2]. Radical nephroureterectomy (RNU) with the removal of the bladder cuff is the standard treatment of UTUC, including high-risk noninvasive and invasive UTUC [3, 4]. The incidence of invasive UTUC (approximately 60%) is much higher than that of bladder cancer. The prognosis of UTUC is poor worldwide, with a recurrence rate ranging from 30% to 75% [2, 5]. An exploration of the potential prognostic factors in UTUC is important for risk classification. Many studies have indicated that older age, a history of bladder cancer, a higher tumor stage, a higher tumor grade, lymph node metastasis, multifocality, and hydronephrosis are predictors of disease recurrence or survival [1, 5, 6]
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