Metastasectomy could not improve the survival of metastatic urothelial carcinoma: evidence from a meta-analysis

BACKGROUND: With the advancement of surgical techniques and instruments, surgeries had been increasingly applied to patients with metastatic urothelial carcinoma. However, their survival benefits had not been carefully evaluated. METHODS: Eligible articles were conducted by comprehensively searching three online databases (PubMed, EMBASE and Web of Science), published before May 1st, 2019. Overall survival (OS) and cancer-specific survival/progression-free survival (CSS/PFS) were analyzed to clarify their associations. RESULTS: Finally, eight out of 3,581 articles were enrolled in this meta-analysis. In terms of OS, our results indicated that OS was positively associated with the patients underwent radical cystectomy (RC) (pooled HR =0.72, 95% CI, 0.64–0.81, P=0.158, I(2)=39.4%), but it was not significantly associated with the patients underwent metastasectomy (MC) (pooled HR =0.78, 95% CI, 0.56–1.08, P=0.093, I(2)=49.7%). As for CSS/PFS, our results displayed that patients could benefit from surgery (RC or MC) (pooled HR =0.56, 95% CI, 0.42–0.75, P=0.213, I(2)=35.3%). CONCLUSIONS: Despite the positive role of the RC in treating metastatic urothelial carcinoma, MC did not suggest a survival benefit in terms of OS. More strictly designed randomized controlled trials (RCTs) were needed to validate our findings.