上尿路尿路上皮癌患者根治性肾输尿管切除术后膀胱内复发危险因素的Meta分析

Risk factors for intravesical recurrence after radical nephroureterectomy of upper tract urothelial carcinoma: a meta-analysis

目的系统评价上尿路尿路上皮癌(UTUC)患者根治性肾输尿管切除(RNU)术后膀胱内复发(IVR)的危险因素。方法计算机检索Pub Med、EMbase、The Cochrane Library、CBM、CNKI、VIP和Wan Fang Data数据库,搜集有关UTUC患者RNU术后IVR危险因素的病例-对照研究,检索时限均为建库至2017年8月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入23个研究,包括8 614例患者。Meta分析结果显示:既往膀胱癌病史[HR=1.77,95%CI(1.42,2.22),P<0.001]、肿瘤分期(≥T2)[HR=1.41,95%CI(1.09,1.82),P=0.009]、输尿管肿瘤[HR=1.34,95%CI(1.20,1.49),P<0.000 01]、多发性肿瘤[HR=1.51,95%CI(1.34,1.69),P<0.001]、淋巴血管浸润[HR=1.43,95%CI(1.20,1.70),P<0.0001]、腹腔镜手术[HR=1.52,95%CI(1.08,2.15),P=0.02]、肿瘤切缘阳性[HR=1.87,95%CI(1.17,2.99),P=0.009]和术前输尿管镜检查[HR=1.46,95%CI(1.21,1.75),P<0.001]均是UTUC患者RNU术后IVR的危险因素。结论当前证据表明,既往膀胱癌病史、肿瘤分期(≥T2)、输尿管肿瘤等是UTUC患者RNU术后IVR的危险因素。受纳入研究质量限制,上述结论尚待更多高质量研究予以验证。

ObjectiveTo systematically review the risk factors for intravesical recurrence （IVR） after radical nephroureterectomy （RNU） of upper tract urothelial carcinoma （UTUC）.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies about the risk factors for IVR after RNU of UTUC from inception to August 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 studies involving 8 614 patients were included. The results of meta-analysis showed that the history of bladder cancer （HR=1.77, 95%CI 1.42 to 2.22, P〈0.001）, tumor stage （≥T2） （HR=1.41, 95%CI 1.09 to 1.82,P=0.009）, ureteral tumor （HR=1.34, 95%CI 1.20 to 1.49, P〈0.000 01）, tumor multifocality （HR=1.51, 95%CI 1.34 to 1.69,P〈0.001）, lymphovascular invasion （HR=1.43, 95%CI 1.20 to 1.70,P〈0.000 1）, laparoscopic surgery （HR=1.52, 95%CI 1.08 to 2.15,P=0.02）, positive surgical margins （HR=1.87, 95%CI 1.17 to 2.99, P=0.009）, and preoperative ureteroscopy （HR=1.46, 95%CI 1.21 to 1.75, P〈0.001） were the risk factors for IVR after RNU.ConclusionsCurrent evidence shows that the risk factors for IVR after RNU include history bladder cancer, tumor stage （≥T2）, ureteral tumor, etc. Due to the limited quality of the included studies, more high quality studies are required to verify the above conclusion.