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Impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: A protocol for systematic review and meta analysis
PURPOSE: Controversy remains with using neoadjuvant chemotherapy (NAC) in patients with upper tract urothelial carcinoma (UTUC). Thus, we conducted a systematic review and meta-analysis of the peer-reviewed literature to assess the role of NAC in high-risk UTUC patients. METHODS: PubMed, EMBASE, and...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440286/ https://www.ncbi.nlm.nih.gov/pubmed/32358407 http://dx.doi.org/10.1097/MD.0000000000020184 |
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author | Li, Kun Xie, Wenjie Gao, Liang Huang, Gaomin Zhou, Jiaming Mei, Baoyu Chen, Jie |
author_facet | Li, Kun Xie, Wenjie Gao, Liang Huang, Gaomin Zhou, Jiaming Mei, Baoyu Chen, Jie |
author_sort | Li, Kun |
collection | PubMed |
description | PURPOSE: Controversy remains with using neoadjuvant chemotherapy (NAC) in patients with upper tract urothelial carcinoma (UTUC). Thus, we conducted a systematic review and meta-analysis of the peer-reviewed literature to assess the role of NAC in high-risk UTUC patients. METHODS: PubMed, EMBASE, and the Cochrane Library were the main sources of relevant studies. The search terms included: “Upper urothelial carcinoma”; “UTUC”; “Urinary tract cancer”; and “Transitional cell carcinoma” combined with “Neoadjuvant chemotherapy” and “adjuvant chemotherapy”. We studied the relationship of UTUC and NAC. Overall survival, recurrent-free survival, cancer-specific survival and pathological response rate in patients treated with/without NAC before radical surgery were evaluated. RESULTS: Five trials were selected, and included 532 participants. Each of the included studies was retrospective. The combined analysis showed that when compared to controls, the pooled hazard ratios of overall survival, recurrence-free survival and cancer-specific survival were 0.47 (95% confidence interval [CI], 0.34–0.64; P < .00001); 0.50 (95% CI, 0.37–0.66; P < .00001); and 0.37 (95% CI, 0.25–0.54; P < .00001), respectively. It indicates the beneficial effects of NAC for the prognosis of survival in UTUC. Additionally, NAC was significantly associated with T-stage down-grading (T3/4 to ≤T2; OR=7.58 [4.66, 12.33]; P < .0001) and pathological lymph node status (N+ to N0; OR = 6.24 [2.57,15.15]; P < .00001). CONCLUSIONS: NAC treatment before radical nephron-ureterectomy significantly improves survival prognosis in patients with high-risk upper tract urothelial carcinoma. However, considerable prospective and randomized studies are needed to confirm this perspective. |
format | Online Article Text |
id | pubmed-7440286 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-74402862020-09-04 Impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: A protocol for systematic review and meta analysis Li, Kun Xie, Wenjie Gao, Liang Huang, Gaomin Zhou, Jiaming Mei, Baoyu Chen, Jie Medicine (Baltimore) 7300 PURPOSE: Controversy remains with using neoadjuvant chemotherapy (NAC) in patients with upper tract urothelial carcinoma (UTUC). Thus, we conducted a systematic review and meta-analysis of the peer-reviewed literature to assess the role of NAC in high-risk UTUC patients. METHODS: PubMed, EMBASE, and the Cochrane Library were the main sources of relevant studies. The search terms included: “Upper urothelial carcinoma”; “UTUC”; “Urinary tract cancer”; and “Transitional cell carcinoma” combined with “Neoadjuvant chemotherapy” and “adjuvant chemotherapy”. We studied the relationship of UTUC and NAC. Overall survival, recurrent-free survival, cancer-specific survival and pathological response rate in patients treated with/without NAC before radical surgery were evaluated. RESULTS: Five trials were selected, and included 532 participants. Each of the included studies was retrospective. The combined analysis showed that when compared to controls, the pooled hazard ratios of overall survival, recurrence-free survival and cancer-specific survival were 0.47 (95% confidence interval [CI], 0.34–0.64; P < .00001); 0.50 (95% CI, 0.37–0.66; P < .00001); and 0.37 (95% CI, 0.25–0.54; P < .00001), respectively. It indicates the beneficial effects of NAC for the prognosis of survival in UTUC. Additionally, NAC was significantly associated with T-stage down-grading (T3/4 to ≤T2; OR=7.58 [4.66, 12.33]; P < .0001) and pathological lymph node status (N+ to N0; OR = 6.24 [2.57,15.15]; P < .00001). CONCLUSIONS: NAC treatment before radical nephron-ureterectomy significantly improves survival prognosis in patients with high-risk upper tract urothelial carcinoma. However, considerable prospective and randomized studies are needed to confirm this perspective. Wolters Kluwer Health 2020-05-01 /pmc/articles/PMC7440286/ /pubmed/32358407 http://dx.doi.org/10.1097/MD.0000000000020184 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 |
spellingShingle | 7300 Li, Kun Xie, Wenjie Gao, Liang Huang, Gaomin Zhou, Jiaming Mei, Baoyu Chen, Jie Impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: A protocol for systematic review and meta analysis |
title | Impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: A protocol for systematic review and meta analysis |
title_full | Impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: A protocol for systematic review and meta analysis |
title_fullStr | Impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: A protocol for systematic review and meta analysis |
title_full_unstemmed | Impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: A protocol for systematic review and meta analysis |
title_short | Impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: A protocol for systematic review and meta analysis |
title_sort | impact of neoadjuvant chemotherapy on survival prognosis and pathological downstaging in patients presenting with high-risk upper tract urothelial carcinoma: a protocol for systematic review and meta analysis |
topic | 7300 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440286/ https://www.ncbi.nlm.nih.gov/pubmed/32358407 http://dx.doi.org/10.1097/MD.0000000000020184 |
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