Single-dose intravesical chemotherapy after nephroureterectomy for upper tract urothelial carcinoma

Hwang, Eu Chang; Sathianathen, Niranjan; Jung, Jae Hung; Kim, Myung Ha; Dahm, Philipp

doi:10.1002/14651858.cd013160.pub2

Cited by 31 publications

(34 citation statements)

References 57 publications

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“…Current guidelines recommend a single postoperative instillation of intravesical chemotherapy after RNU, as several trials and meta-analyses showed an approximately 40% relative risk reduction of IVR after administration of a single postoperative dose of intravesical chemotherapy (mitomycin C or pirarubicin) [ 2 , 38 ]. Although we demonstrated that URS prior to RNU is associated with significantly worse IVRFS than RNU alone in patients not receiving immediate intravesical installation following RNU, we were unable to perform subgroup analyses for the subset of patients who received adjuvant intravesical treatment due to a paucity of data.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Nowak

Krajewski

Chorbińska

et al. 2021

JCM

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Background: The incidence of intravesical recurrence (IVR) following radical nephroureterectomy (RNU) is reported in up to 50% of patients with upper tract urothelial carcinoma (UTUC). It was suggested that preoperative diagnostic ureteroscopy (URS) could increase the IVR rate after RNU. However, the available data are often conflicting. Thus, in this systematic review and meta-analysis we sought to synthesize available data for the impact of pre-RNU URS for UTUC on IVR and other oncological outcomes. Materials and methods: A systematic literature search of the PubMed, Embase, and Cochrane Library databases was performed in June 2021. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CI) were conducted. The primary endpoint was intravesical recurrence-free survival (IVRFS), with the secondary endpoints being cancer-specific survival (CSS), overall survival (OS), and metastasis-free survival (MFS). Results: Among a total of 5489 patients included in the sixteen selected papers, 2387 (43.4%) underwent diagnostic URS before RNU and 3102 (56.6%) did not. Pre-RNU diagnostic URS was significantly associated with worse IVRFS after RNU (HR = 1.44, 95% CI: 1.29–1.61, p < 0.001) than RNU alone. However, subgroup analysis including patients without biopsy during URS revealed no significant impact of diagnostic URS on IVRFS (HR = 1.28, 95% CI: 0.90–1.80, p = 0.16). The results of other analyses showed no significant differences in CSS (HR = 0.94, p = 0.63), OS (HR: 0.94, p = 0.56), and MFS (HR: 0.91, p = 0.37) between patients who underwent URS before RNU and those who did not. Conclusions: The results of this meta-analysis confirm that diagnostic URS prior to RNU is significantly associated with worse IVRFS, albeit with no concurrent impact on the other long-term survival outcomes. Our results indicate that URS has a negative impact on IVRFS only when combined with endoscopic biopsy. Future studies are warranted to assess the role of immediate postoperative intravesical chemotherapy in patients undergoing biopsy during URS for suspected UTUC.

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Section: Discussionmentioning

confidence: 99%

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Nowak

Krajewski

Chorbińska

et al. 2021

JCM

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“…Two meta-analyses have reported lower BRRs in patients receiving intravesical chemotherapy after RNU, and early instillation seems to be of importance as well as single-dose instillation is comparable with multiple instillations [14] , [15] .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Mitomycin C Bladder Instillation During Radical Nephroureterectomy Is Feasible and Safe

Nadler

Oedorf

Jensen

et al. 2021

European Urology Open Science

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“…Although we demonstrated that URS prior to RNU is associated with significantly worse IVRFS than RNU alone in patients not receiving immediate intravesical installation following RNU or perioperative systemic chemotherapy, we were unable to perform subgroup analyses for populations of patients who received any form of neoadjuvant or adjuvant treatment due to lack of data. Give that single-dose intravesical chemotherapy give for up to postoperative 10 days reduces the risk of IVR within the first post-RNU years and that systemic chemotherapy has a significant beneficial effect on oncological outcomes in patients with UTUC [37,38], further studies including cohorts of patients receiving perioperative chemotherapy are necessary to make preliminary conclusions regarding the impact of URS prior to RNU on IVRFS in such setting.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-analysis

Nowak

Krajewski

Chorbińska

et al. 2021

Preprint

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Background: The incidence of intravesical recurrence (IVR) following radical nephroureterectomy (RNU) is reported in up to 50% of patients with upper tract urothelial carcinoma (UTUC). It was suggested that preoperative diagnostic ureteroscopy (URS) could increase the IVR rate after RNU, however, the available data are often conflicting. Thus, in this systematic review and meta-analysis we sought to synthesize that available data for the impact of pre-RNU URS for UTUC on IVR and other oncological outcomes; Materials and methods: A systematic literature search of the PubMed, Embase and Cochrane Library databases was performed in June 2020. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CI) were conducted. The primary endpoint was intravesical recurrence-free survival (IVRFS), with the secondary endpoints being cancer-specific survival (CSS), overall survival (OS), and metastasis-free survival (MFS); Results: Among a total of 5489 patients included in the sixteen selected papers, 2387 (43.4%) underwent diagnostic URS before RNU and 3102 (56.6%) did not. Pre-RNU diagnostic URS was significantly associated with worse IVRFS after RNU (HR=1.44, 95% CI: 1.29-1.61, p&lt;0.001) than RNU alone. However, subgroup analysis including patients without biopsy during URS revealed no significant impact of diagnostic URS on IVRFS (HR=1.28, 95% CI: 0.90-1.80, p=0.16). The results of other analyses showed no significant differences in CSS (HR=0.94, p=0.63), OS (HR: 0.94, p=0.56), and MFS (HR: 0.91, p=0.37) between patients who underwent URS before RNU and those who did not. Conclusions: The results of this meta-analysis confirm that diagnostic URS prior to RNU is significantly associated with worse IVRFS, albeit with no concurrent impact on the other long-term survival outcomes. Our results indicate that URS has a negative impact on IVRFS only when combined with endoscopic biopsy. Future studies are warranted to assess the role of immediate postoperative intravesical chemotherapy in patients undergoing biopsy during URS for suspected UTUC.

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Single-dose intravesical chemotherapy after nephroureterectomy for upper tract urothelial carcinoma

Abstract: Single-dose intravesical chemotherapy a er nephroureterectomy for upper tract urothelial carcinoma.

Cited by 31 publications

References 57 publications

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Intraoperative Mitomycin C Bladder Instillation During Radical Nephroureterectomy Is Feasible and Safe

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-analysis

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