Abstract
Background: Upper tract urothelial carcinoma (UTUC) accounts for up to 10% of all urothelial neoplasms. Currently, various tumor-related factors are proposed to be of importance in UTUC prognostic models; however, the association of the primary UTUC location with oncological outcomes remains controversial. Thus, we sought to perform a systematic review and meta-analysis of the latest available evidence and assess the impact of primary tumor location on long-term oncological outcomes in patients with UTUC undergoing radical nephroureterectomy. Materials and Methods: A computerized systematic literature search was conducted in October 2021 through the PubMed, Web of Science, Scopus, and Cochrane Library databases. The primary endpoint was cancer-specific survival (CSS), and the secondary endpoints were overall survival (OS) and disease-free survival (DFS). Effect measures for the analyzed outcomes were reported hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among the total number of 16,836 UTUC in 17 included studies, 10,537 (62.6%) were renal pelvic tumors (RPTs), and 6299 (37.4%) were ureteral tumors (UTs). Pooled results indicated that patients with UT had significantly worse CSS (HR: 1.37, p < 0.001), OS (HR: 1.26, p = 0.003, and DFS (HR: 1.51, p < 0.001) compared to patients with RPT. Based on performed subgroup analyses, we identified different definitions of primary tumor location and geographical region as potential sources of heterogeneity. Conclusions: Ureteral location of UTUC is associated with significantly worse long-term oncological outcomes. Our results support the need for close follow-up and the consideration of perioperative chemotherapy in patients with UTUC located in the ureter. However, further prospective studies are needed to draw final conclusions.
Highlights
Upper tract urothelial carcinoma (UTUC) arising from the epithelium lining of the pyelocaliceal cavities or ureter accounts for 5–10% of all urothelial neoplasms [1]
In accordance with the study inclusion criteria, 17 and 6 manuscripts were excluded for insufficient outcome and inclusion of patients receiving kidney-sparing management, respectively
In the present systematic review and meta-analysis, we demonstrated that ureteral location of UTUC was associated with significantly worse long-term oncological outlocation of UTUC was associated with significantly worse long-term oncological outcomes comes (CSS, overall survival (OS), disease-free survival (DFS)) compared to Renal pelvic tumors (RPT)
Summary
Upper tract urothelial carcinoma (UTUC) arising from the epithelium lining of the pyelocaliceal cavities or ureter accounts for 5–10% of all urothelial neoplasms [1]. Various tumor-related factors have been proposed by the European Association of Urology (EAU) to be of importance in UTUC risk stratification and prognostic models [2]. These include, e.g., tumor stage and grade, presence of lymphovascular invasion (LVI), or tumor architecture. Various tumor-related factors are proposed to be of importance in UTUC prognostic models; the association of the primary UTUC location with oncological outcomes remains controversial. We sought to perform a systematic review and meta-analysis of the latest available evidence and assess the impact of primary tumor location on long-term oncological outcomes in patients with UTUC undergoing radical nephroureterectomy. Further prospective studies are needed to draw final conclusions
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