The role of primary tumour site surgery in metastatic UTUC: a systematic review and meta-analysis.

IF 3.7 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International Pub Date : 2025-07-03 DOI:10.1111/bju.16836

Ludovica Cella,Stefano Moretto,Roberto Contieri,Alessandro Uleri,Pier Paolo Avolio,Andrea Piccolini,Benedetto Calabrese,Vittorio Fasulo,Rodolfo Hurle,Massimo Lazzeri,Alberto Saita,Laura S Mertens,Bas W G van Rhijn,Benjamin Pradere,Alexander P Cole,Thomas Seisen,Paolo Casale,Giovanni Lughezzani,Nicolò Maria Buffi,Marco Paciotti

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引用次数: 0

Abstract

OBJECTIVE To assess the impact of primary tumour surgery on survival outcomes in patients with metastatic upper urinary tract urothelial carcinoma (mUTUC) by conducting a systematic review and meta-analysis. METHODS A systematic search was conducted using the PubMed/Medline, Embase, Web of Science, and Cochrane Library databases for studies published up to January 2025, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies included adult patients (≥18 years) diagnosed with mUTUC (cM+ excluding cN + M0). The intervention assessed was primary tumour surgery, compared to non-surgical management, including chemotherapy, immunotherapy, radiation therapy, or best supportive care. Key outcomes measured were surgical/peri-operative outcomes, progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). RESULTS Ten eligible retrospective studies were identified. Most reported a significant improvement in survival outcomes (PFS, CSS and OS) for patients undergoing primary tumour surgery compared to systemic therapy (STx) alone. Surgery was notably associated with superior OS both for STx plus consolidative surgery (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.55-0.81) and cytoreductive surgery plus STx (HR 0.73, 95% CI 0.68-0.78). The most favourable outcomes were observed in younger patients and those with a single metastatic site. CONCLUSIONS Surgery may improve survival outcomes in mUTUC compared to non-surgical options. However, the current evidence is mainly derived from retrospective studies with potential selection bias. Prospective studies are needed to confirm these findings and establish criteria for selecting patients who could benefit from surgical intervention.

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原发肿瘤部位手术在转移性UTUC中的作用：系统回顾和荟萃分析。

目的通过系统回顾和荟萃分析，评估原发性肿瘤手术对转移性上尿路尿路上皮癌（mUTUC）患者生存结局的影响。方法使用PubMed/Medline、Embase、Web of Science和Cochrane Library数据库进行系统检索，检索截至2025年1月发表的研究，使用系统评价和荟萃分析首选报告项目（PRISMA）指南。符合条件的研究包括诊断为mUTUC （cM+， cN + M0除外）的成年患者（≥18岁）。评估的干预措施是原发性肿瘤手术，与非手术治疗相比，包括化疗、免疫治疗、放射治疗或最佳支持治疗。测量的主要结果是手术/围手术期结果、无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）。结果确定了10项符合条件的回顾性研究。大多数报告称，与单独进行全身治疗（STx）相比，接受原发性肿瘤手术的患者的生存结果（PFS、CSS和OS）有显著改善。STx +巩固手术（风险比[HR] 0.66, 95%可信区间[CI] 0.55-0.81）和细胞减少手术+ STx（风险比[HR] 0.73, 95%可信区间[CI] 0.68-0.78）的手术均与较好的OS显著相关。最有利的结果是在年轻患者和那些只有一个转移部位。结论：与非手术相比，手术可改善mUTUC的生存结果。然而，目前的证据主要来自具有潜在选择偏差的回顾性研究。需要前瞻性研究来证实这些发现，并建立选择可以从手术干预中获益的患者的标准。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.