Survival differences of patients with ureteral versus pelvicalyceal tumours: a systematic review and meta-analysis

Kaczmarek, Krystian; Lemiński, Artur; Gołąb, Adam; Słojewski, Marcin

doi:10.5114/aoms.2019.89893

Cited by 7 publications

(7 citation statements)

References 61 publications

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“…Contrary to this study, we performed recurrence analysis based on strict and unequivocal criteria. Subsequently, Kaczmarek et al showed that ureteral involvement of UTUC is significantly associated with worse CSS and OS [4]. However, despite the good methodological quality, this study lacked data regarding recurrence, as well as profound subgroup analyses explaining high heterogeneity of obtained results [4].…”

Section: Discussionmentioning

confidence: 88%

“…Subsequently, Kaczmarek et al showed that ureteral involvement of UTUC is significantly associated with worse CSS and OS [4]. However, despite the good methodological quality, this study lacked data regarding recurrence, as well as profound subgroup analyses explaining high heterogeneity of obtained results [4]. Therefore, for the first time, we provided a detailed analysis of long-term oncological outcomes based on several new stratification variables.…”

Section: Discussionmentioning

confidence: 95%

“…The previously conducted meta-analyses suggested that UT could be associated with worse prognosis compared to RPT [3,4]. In recent years, several new studies have contributed relevant information toward the prognostic implications of the primary UTUC location.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Primary Tumor Location on Long-Term Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Krajewski

Nowak

Małkiewicz

et al. 2021

JPM

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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.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 95%

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The Impact of Primary Tumor Location on Long-Term Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Krajewski

Nowak

Małkiewicz

et al. 2021

JPM

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“…Hydronephrosis is often present on imaging (up to 50% of cases), and multiple studies have shown that hydronephrosis is associated with higher stage at diagnosis ( 41 , 42 ). Additionally, after adjusting for tumor stage, patients with ureteral and/or multifocal tumors appear to have a worse prognosis than patients with renal pelvic tumors ( 97 , 98 ). Larger tumors are more likely to be muscle-invasive and/or non-organ-confined in both ureteral and renal pelvis UTUC—with 2 cm being the best cut-off in identifying patient's with an increased risk of pT2 UTUC or higher ( 99 ).…”

Section: Risk Stratificationmentioning

confidence: 99%

Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma

Zganjar,

Thiel,

Lyon

2023

Transl Androl Urol

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Upper tract urothelial carcinoma (UTUC) is a relatively rare disease that presents unique challenges to urologists from both a diagnostic and management standpoint. UTUC is a clinically heterogenous disease with a varied natural history, and given its location in the upper urinary tract, treatment has the potential to cause or worsen chronic kidney disease. Therefore, physicians caring for patients with UTUC must be facile with multiple diagnostic and therapeutic strategies in order to provide optimal patient care. We present an overview of the epidemiology, histology, risk factors, and contemporary approach to the diagnosis, laboratory evaluation, imaging, and risk stratification for patients with UTUC. Computerized tomographic urography, thorough endoscopic evaluation, and biopsy (endoscopically or percutaneously) remain the standard of care for the diagnosis and staging of patients with suspected UTUC. Preoperative nomograms are vital to select patients more optimally for preoperative systemic chemotherapy and facilitate clinical trial enrollment. A thorough understanding of the various diagnostic challenges, imaging/pathologic limitations, biomarkers, and risk stratification tools will allow us as a field to develop new modalities to improve our diagnostic capabilities and reduce the risk of under diagnosis and over treatment for our patients.

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“…Tumor location has been shown to be associated with worse outcomes in univariable analyses [ 27 ]. According to a systematic review of 14,895 RNU patients, ureteral tumor location has a negative impact on CSS compared to pelvicalyceal tumors after adjusting for covariates (pooled HR of 1.52, p < 0.001) [ 28 ]. Multifocality is another factor that has been associated with disease recurrence and CSS in 2492 RNU patients, of whom 590 had multifocal tumors (HR 1.43, p = 0.019 and HR 1.46, p = 0.027, respectively) [ 29 ].…”

Section: Prognostic Factors For Utucmentioning

confidence: 99%

Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease

Klemm,

Bekku,

Abufaraj

et al. 2023

Cancers

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Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.

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Survival differences of patients with ureteral versus pelvicalyceal tumours: a systematic review and meta-analysis

Cited by 7 publications

References 61 publications

The Impact of Primary Tumor Location on Long-Term Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

The Impact of Primary Tumor Location on Long-Term Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma

Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease

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