The Impact of Primary Tumor Location on Long-Term Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Abstract

Background: Upper tract urothelial carcinoma (UTUC) accounts for up to 10% of all urothelial neoplasms. Currently, various tumor-related factors are proposed to be of importance in UTUC prognostic models; however, the association of the primary UTUC location with oncological outcomes remains controversial. Thus, we sought to perform a systematic review and meta-analysis of the latest available evidence and assess the impact of primary tumor location on long-term oncological outcomes in patients with UTUC undergoing radical nephroureterectomy. Materials and Methods: A computerized systematic literature search was conducted in October 2021 through the PubMed, Web of Science, Scopus, and Cochrane Library databases. The primary endpoint was cancer-specific survival (CSS), and the secondary endpoints were overall survival (OS) and disease-free survival (DFS). Effect measures for the analyzed outcomes were reported hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among the total number of 16,836 UTUC in 17 included studies, 10,537 (62.6%) were renal pelvic tumors (RPTs), and 6299 (37.4%) were ureteral tumors (UTs). Pooled results indicated that patients with UT had significantly worse CSS (HR: 1.37, p < 0.001), OS (HR: 1.26, p = 0.003, and DFS (HR: 1.51, p < 0.001) compared to patients with RPT. Based on performed subgroup analyses, we identified different definitions of primary tumor location and geographical region as potential sources of heterogeneity. Conclusions: Ureteral location of UTUC is associated with significantly worse long-term oncological outcomes. Our results support the need for close follow-up and the consideration of perioperative chemotherapy in patients with UTUC located in the ureter. However, further prospective studies are needed to draw final conclusions.

The Impact of Surgical Waiting Time on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy: A Systematic Review

“…Ureteral location is considered as an important negative prognostic factor in patients with UTUC. Recent meta-analysis including 10,537 patients with RPT and 6299 patients with UT demonstrated that ureteral location of UTUC is associated with decreased CSS, OS, and DFS [ 19 ]. More aggressive behavior of UT, potentially related to tumor’s surrounding environment (e.g., thin periureteral layer of muscular and fatty tissue, compared to renal parenchyma), raises the question about the safe delay interval in radical treatment.…”

Oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma: a literature review

“…A difference in risk based on primary tumor location was found in a meta-analysis by Krajewski et al of over 16,000 patients ( 85 ). Patients with ureteral tumors were found to have significantly worse cancer-specific survival, overall survival, and disease-free survival than patients with renal pelvic tumors ( 85 ). Another meta-analysis by Wu et al reported similar findings, except for patients with pT3/4 and pN+ tumors ( 86 ).…”