Effects of Adjuvant Chemotherapy on Locally Advanced Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis

Abstract

INTRODUCTION:

We aimed to perform a systematic review and meta-analysis to evaluate the current role of adjuvant chemotherapy (ACH) after radical nephroureterectomy (RNU) in patients with locally advanced upper tract urothelial carcinoma (UTUC).

MATERIALS AND METHODS:

The PubMed/MEDLINE, EMBASE, and Cochrane Library databases were searched for relevant studies in English from January 1980 to April 2019. The inclusion criteria was determined based on the population, intervention, comparator, outcome, and study design. The endpoints were disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS). Hazard ratios (HRs) and 95% confidence intervals (CIs) of each endpoint were extracted from the included studies.

RESULTS:

A total of 11 studies were included in the final analysis to investigate the role of ACH in locally advanced UTUC. Overall, 798 patients received ACH after RNU, and 1496 patients underwent RNU alone. The pooled HRs for DFS, CSS, and OS among the studies were 0.59 (95% CI, 0.43-0.81; P = .001), 0.73 (95% CI, 0.55-0.95; P = .02), and 0.84 (95% CI, 0.59-1.19; P = .32), respectively. The quality of evidence of each outcome determined by the Grading of Recommendations, Assessments, Developments, and Evaluation approach was low for 2 outcomes and very low for the other outcome.

CONCLUSIONS:

ACH following RNU may improve DFS and CSS in patients with locally advanced UTUC. When comparing previously reported meta-analysis of all UTUC patients, the beneficial effects of ACH on CSS might be more pronounced in patients with locally advanced UTUC.