Should Patients With Primary Upper Urinary Tract Cancer Receive Prophylactic Intravesical Chemotherapy After Nephroureterectomy?

Wu, Wen‐Jeng; Ke, Hung‐Lung; Yang, Yi‐Hsin; Li, Ching-Chia; Chou, Yii‐Her; Huang, Chun‐Hsiung

doi:10.1016/j.juro.2009.08.154

Cited by 50 publications

(51 citation statements)

References 24 publications

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“…A total of 7 trials focused on this topic and potentially met the selection criteria [21,22,23,24,25,26,27]. Two trials were excluded because some patients underwent radical nephrectomy instead of nephroureterectomy [26,27] and because some patients received intravesical instillation before surgery in one trial [26].…”

Section: Resultsmentioning

confidence: 99%

“…Two trials were excluded because some patients underwent radical nephrectomy instead of nephroureterectomy [26,27] and because some patients received intravesical instillation before surgery in one trial [26]. Five trials were retained, including four published articles [21,22,23,25] and one meeting program abstract from the AUA annual meeting [24]. …”

Section: Resultsmentioning

confidence: 99%

“…The best time to administer the first instillation is within 24 h after transurethral resection [29], while the instillation times and schedule after nephroureterectomy are uncertain. The first instillation in all trials was given about 1-2 weeks after surgery, and additional instillations were given in three trials [22,23,25]. Implantation might already have irreversibly occurred 7-10 days after nephroureterectomy, but the investigators believe it is better not to administer the chemotherapy before the bladder heals to prevent extravasation [21].…”

Section: Discussionmentioning

confidence: 99%

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Prophylactic Intravesical Chemotherapy to Prevent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinomas: A Systematic Review and Meta-Analysis

Fang¹,

Li²,

Xiong³

et al. 2013

Urol Int

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Introduction: Intravesical recurrence after treatment of primary upper urinary tract urothelial carcinomas (UUT-UCs) is common. While intravesical instillation is widely used to prevent recurrence after transurethral resection for primary bladder tumors, there is still no consensus on the prophylactic capability of intravesical chemotherapy in preventing bladder tumor recurrence after surgery for UUT-UCs. Methods: A meta-analysis of the published results of clinical trials was performed to compare radical surgery alone or surgery plus postoperative intravesical chemotherapy. The primary end point was to determine the percentage of patients with recurrence in the different groups. Results: Our study includes five trials with recurrence information on 614 patients. During follow-up, 55 of 268 (20.5%) patients who received postoperative instillation had bladder recurrence compared to 127 of 346 (36.7%) patients who had no adjuvant treatment - a decrease of 41% in the odds of recurrence with chemotherapy (odds ratio 0.48, 95% confidence interval 0.33-0.69, p = 0.0001). No serious adverse events were reported. Subgroup analyses were temporarily unavailable. Conclusions: Postoperative intravesical chemotherapy significantly decreases the risk of bladder recurrence after nephroureterectomy for primary UUT-UCs. Postoperative intravesical instillation is considered the treatment of choice after nephroureterectomy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prophylactic Intravesical Chemotherapy to Prevent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinomas: A Systematic Review and Meta-Analysis

Fang¹,

Li²,

Xiong³

et al. 2013

Urol Int

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“…Wu et al [22] reported the effectiveness of adjuvant intravesical chemotherapy right after NUx. They concluded that adjuvant intravesical chemotherapy could decrease the risk for recurrence and extend the time until the first recurrence.…”

Section: Discussionmentioning

confidence: 99%

Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma

et al. 2011

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“…However, approximately 20-50% of patients experience bladder recurrence after RNU [1] . Cur-rently, prophylactic intravesical chemotherapy after RNU is one of the few available treatments effective in preventing secondary bladder cancer (Bca), but the optimal chemotherapy regimen and the initial time of instillation remain controversial [3][4][5] . Moreover, it is improper for all patients to receive the same intravesical chemotherapy regimen because this would lead to excessive treatment for low-risk patients.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Recurrent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinoma: An Individualized Selection Strategy Based on Patient Risk Stratification Is Needed

Long

et al. 2016

Urol Int

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Objective: To evaluate the efficacies of different chemotherapy regimens in different risk sub-groups for the prevention of bladder recurrence after radical nephroureterectomy (RNU). Materials and Methods: Between 2004 and 2012, we recruited 685 patients who underwent RNU for upper tract urothelial carcinoma at 4 Chinese institutions. We assessed whether the type of intravesical chemotherapy regimen affected the bladder recurrence rate in patients with different risk levels after RNU. Results: For all patients, the bladder recurrence rate was lower with intravesical chemotherapy than without, but no significant differences were found between the 2 intravesical chemotherapy regimens (single dose or relatively long-term therapy). We used multivariate analysis to define the risk factors for bladder recurrence and stratified patients into low-, intermediate-, and high-risk sub-groups accordingly. The bladder recurrence rate in the low-risk patients was not significantly different between patients with or without intravesical chemotherapy. However, in the intermediate-risk and high-risk patients, the rate was greater in patients without intravesical chemotherapy than in patients with. Furthermore, the rate was not significantly different between the 2 intravesical chemotherapy regimens in the intermediate-risk patients, while the efficacy of the relatively long-term regimen in high-risk patients remains unclear. Conclusions: Our study showed that an individualized strategy based on patient risk stratification is needed.

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Should Patients With Primary Upper Urinary Tract Cancer Receive Prophylactic Intravesical Chemotherapy After Nephroureterectomy?

Abstract: Intravesical instillation of epirubicin or mitomycin C appears to be well tolerated and effective for preventing bladder recurrence and prolonging time to first bladder recurrence. Patients should receive prophylactic intravesical chemotherapy after nephroureterectomy.

Cited by 50 publications

References 24 publications

Prophylactic Intravesical Chemotherapy to Prevent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinomas: A Systematic Review and Meta-Analysis

Prophylactic Intravesical Chemotherapy to Prevent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinomas: A Systematic Review and Meta-Analysis

Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Prevention of Recurrent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinoma: An Individualized Selection Strategy Based on Patient Risk Stratification Is Needed

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