Intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy occurs in 22% to 47%. Intravesical chemotherapy is still underused due to concerns about its efficacy and safety. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of intravesical chemotherapy regimens in reducing the risk of intravesical recurrence following radical nephroureterectomy.
A literature search was conducted using PubMed/Medline, Embase, and Web of Science databases to identify reports published until March 2024. The PRISMA guidelines were followed to identify eligible studies. The outcomes measured were intravesical recurrence rates and complications in patients treated with different intravesical instillation chemotherapy and timing after radical nephroureterectomy. Sub-analyses were performed on randomized controlled trials and studies involving patients with no history of bladder cancer.
Eighteen studies met our inclusion criteria, and data from 2,483 patients were reviewed. Intravesical chemotherapy significantly reduced the risk of intravesical recurrence at 12 months (OR = 0.46; 95% CI: 0.33-0.65; P < 0.001;) and at 24 months (OR = 0.41, 95% CI: 0.28-0.61; P < 0.001). Notably, no association was found when confronting intra and postoperative instillations (OR = 0.66; 95% CI: 0.34-1.28; P = 0.2), nor single vs. multiple instillation (OR = 1.37; 95% CI: 0.75-2.50; P = 0.3). The pooled rate for minor and major complications was 9% and 0.9%, respectively.
This study demonstrates that intravesical chemotherapy significantly reduces intravesical recurrence rates after radical nephroureterectomy at 12 and 24 months. Additionally, it underscores the favorable safety profile of intravesical chemotherapy, with a low incidence of major complications. The ideal instillation scheme and chemotherapy agent should be further defined.
Urologic oncology. 2024 Nov 25 [Epub ahead of print]
Stefano Moretto, Andrea Piccolini, Andrea Gallioli, Roberto Contieri, Nicolomaria Buffi, Giovanni Lughezzani, Alberto Breda, Michael Baboudjian, Bas Wg van Rhijn, Morgan Roupret, Alessandro Uleri, Benjamin Pradere
Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Milan, Italy. Electronic address: ., Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Milan, Italy., Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain., Department of Urology, North Academic Hospital, AP-HM, Marseille, France., Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France., Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Milan, Italy; Department of Urology, North Academic Hospital, AP-HM, Marseille, France., Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France.