Assessing the effect of subsequent bladder cancer following radical surgery for upper tract urothelial carcinoma: A systematic review and meta-analysis of prognostic studies

Abstract

Abstract Background To investigate the effect of subsequent bladder cancer (SBCa) following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods PubMed, EMBASE, and the Cochrane Library were exhaustively searched for studies comparing oncological outcomes between SBCa and non-SBCa patients. Standard cumulative analyses using hazard ratios (HR) with 95% confidence intervals (CI) were performed using Review Manager (version 5.3). Results Five studies involving 2,057 patients were selected according to predefined eligibility criteria. Meta-analysis of cancer-specific survival (CSS) and overall survival (OS) revealed no significant differences between the SBCa group and non-SBCa group. However, subgroup analysis of pT0-3N0M0 patients suggested that people with SBCa have worse CSS (HR = 5.13, 95%CI 2.39–10.98, p < 0.0001)and OS (HR = 4.00, 95%CI 2.19–7.31, p < 0.00001). Conclusions SBCa appears to be associated with worse survival in people with early stage UTUC, overall. However, caution must be taken before recommendations are given because this interpretation is based upon very few clinical studies and a small sample. Research sharing more detailed surgical site descriptions, as well as enhanced outcome data collection and improved reporting is required to investigate the nuances further.