Localized Upper Urinary Tract Urothelial Carcinoma (UTUC) is an uncommon cancer typically detected at an advanced stage. Currently, radical nephroureterectomy (RNU) with bladder cuff excision is the standard treatment for high-risk UTUC. This meta-analysis aims to evaluate the 5-year overall and cancer-specific survival and bladder recurrence rates in studies comparing endoscopic kidney-sparing surgeries (E-KSS) with RNU in localized UTUC.
We performed a literature search on 20th April 2023 through PubMed, Web of Science, and Scopus. The PICOS model was used for study inclusion: P: adult patients with localized UTUC; I: E-KSS. C: RNU; O: primary: overall survival (OS); secondary: cancer-specific survival (CSS), bladder recurrence rate, and metastasis-free survival (MFS). S: retrospective, prospective, and randomized studies.
Overall, 11 studies involving 2284 patients were eligible for this meta-analysis, 737 in the E-KSS group and 1547 in the RNU group. E-KSS showed a similar overall 5-year OS between E-KSS and RNU, and for low-grade tumors, while 5-year OS favored RNU for high-grade tumors (RR 1.84, 95% CI 1.26-2.69, p = 0.002). No difference emerged for 5-year CSS between the two groups, even when the results were stratified for low- and high grade tumors. Bladder recurrence rate and 5-year MFS were also similar between the two groups.
Our review showed that E-KSS is a viable option for patients with localized UTUC with non-inferior oncological outcomes as compared with RNU, except for 5-year OS in high-grade tumors which favoured RNU.
World journal of urology. 2024 May 14*** epublish ***
Carlo Giulioni, Carlo Brocca, Pietro Tramanzoli, Silvia Stramucci, Matteo Mantovan, Leonard Perpepaj, Andrea Cicconofri, Vineet Gauhar, Axel Stuart Merseburger, Andrea Benedetto Galosi, Daniele Castellani
Department of Urology, Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, 71 Conca Street, 60126, Ancona, Italy. ., Department of Urology, Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, 71 Conca Street, 60126, Ancona, Italy., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology, University Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.